NEW research has shown that many people with autoimmune hepatitis continue to experience fatigue and poor quality of life, even when their liver enzyme levels have returned to normal. The findings challenge the long-held belief that biochemical remission alone represents full recovery.
Ongoing Burden Despite Treatment Success
A large European cross-sectional study, led by Snijders and colleagues, evaluated 1107 patients with autoimmune hepatitis across 20 centres in 11 countries, alongside 1227 matched controls. Standardised questionnaires, including the EuroQol 5-Dimensions-5-Levels (EQ-5D-5L), the EuroQol Visual Analogue Scale (EQ-VAS), and the Fatigue Impact Scale (FIS), were used to measure health-related quality of life and fatigue.
Although 77% of participants were in biochemical remission at the time of assessment, health-related quality of life scores were markedly lower than those of healthy controls. Median EQ-VAS scores were 75 for patients with autoimmune hepatitis compared with 85 in controls, and almost half (49%) reported moderate-to-severe impairment in at least one area of daily living. Fatigue, pain, and anxiety were among the most frequently reported symptoms, illustrating the persistent burden of disease despite successful biochemical treatment.
Predictors and Management Priorities in Autoimmune Hepatitis
Further analysis identified several independent predictors of poorer outcomes, including female sex, corticosteroid use, cirrhosis, and younger age. Patients receiving corticosteroids had a 75% greater likelihood of moderate-to-severe quality-of-life impairment, underscoring the long-standing concerns over steroid-related side effects.
The authors emphasised that management of autoimmune hepatitis must move beyond liver enzyme normalisation to address the psychological and physical dimensions of recovery. They advocated a more holistic approach that incorporates mental health screening, fatigue management, and cautious steroid use. The team concluded that true remission in autoimmune hepatitis should encompass overall well-being, not merely normal blood test results.
Reference
Snijders R et al. Health-related quality of life and fatigue in autoimmune hepatitis: Results from a European multicentre study. J Hepatol. 2025;82(3):612–23.
