Bernardo de Faria Moraes, Gustavo André Pedral Diniz Leite, Igor Boechat Silveira, Gabriel André Pedral Diniz Leite, Maria Luisa Motta Fonseca, Leonardo Corrêa Suffert, Luisa Medeiros Visentini, Luis Pedro Possapp Beis, Guilherme Grossi Lopes Cançado
Background The role of statins in cirrhosis remains controversial. Historically restricted due to safety concerns, emerging evidence highlights potential pleiotropic benefits, though effects on mortality and decompensation remain uncertain. Aims To evaluate the effects of statin therapy on all‐cause mortality, hepatic decompensation, hepatic venous pressure gradient (HVPG), and hepatocellular carcinoma (HCC) in cirrhosis. Methods We systematically searched major databases until July 2025 for randomised controlled trials (RCTs) and observational studies comparing statin therapy versus non‐use in cirrhosis. Random‐effects meta‐analyses were performed. Results The meta‐analysis included 25 studies (9 RCTs, 16 observational) with 81,992 patients. Statins reduced all‐cause mortality in the overall analysis (unadjusted odds ratio 0.59; 95% CI: 0.48–0.71) and in RCTs (odds ratio 0.45; 95% CI 0.25–0.82), supported by a significant HVPG reduction. Conversely, statins reduced hepatic decompensation in the overall analysis (unadjusted odds ratio 0.56; 95% CI: 0.47–0.66) but not in RCTs (odds ratio 0.75; 95% CI: 0.52–1.09). Observational data indicated a protective association for HCC (adjusted hazard ratio 0.61; 95% CI: 0.46–0.82), and no RCT reported this outcome. Conclusions Statin therapy is associated with improved survival in cirrhosis, supported mechanistically by reductions in portal pressure. Observational evidence suggests benefits for decompensation and HCC, though these remain uncertain due to residual confounding. Large‐scale, long‐term RCTs are needed to clarify the role of statins as disease‐modifying therapy in cirrhosis.
{"title":"Statin Therapy Independently Reduces Mortality and Liver Complications in Patients With Cirrhosis: An Updated Systematic Review and Meta‐Analysis","authors":"Bernardo de Faria Moraes, Gustavo André Pedral Diniz Leite, Igor Boechat Silveira, Gabriel André Pedral Diniz Leite, Maria Luisa Motta Fonseca, Leonardo Corrêa Suffert, Luisa Medeiros Visentini, Luis Pedro Possapp Beis, Guilherme Grossi Lopes Cançado","doi":"10.1111/apt.70526","DOIUrl":"https://doi.org/10.1111/apt.70526","url":null,"abstract":"Background The role of statins in cirrhosis remains controversial. Historically restricted due to safety concerns, emerging evidence highlights potential pleiotropic benefits, though effects on mortality and decompensation remain uncertain. Aims To evaluate the effects of statin therapy on all‐cause mortality, hepatic decompensation, hepatic venous pressure gradient (HVPG), and hepatocellular carcinoma (HCC) in cirrhosis. Methods We systematically searched major databases until July 2025 for randomised controlled trials (RCTs) and observational studies comparing statin therapy versus non‐use in cirrhosis. Random‐effects meta‐analyses were performed. Results The meta‐analysis included 25 studies (9 RCTs, 16 observational) with 81,992 patients. Statins reduced all‐cause mortality in the overall analysis (unadjusted odds ratio 0.59; 95% CI: 0.48–0.71) and in RCTs (odds ratio 0.45; 95% CI 0.25–0.82), supported by a significant HVPG reduction. Conversely, statins reduced hepatic decompensation in the overall analysis (unadjusted odds ratio 0.56; 95% CI: 0.47–0.66) but not in RCTs (odds ratio 0.75; 95% CI: 0.52–1.09). Observational data indicated a protective association for HCC (adjusted hazard ratio 0.61; 95% CI: 0.46–0.82), and no RCT reported this outcome. Conclusions Statin therapy is associated with improved survival in cirrhosis, supported mechanistically by reductions in portal pressure. Observational evidence suggests benefits for decompensation and HCC, though these remain uncertain due to residual confounding. Large‐scale, long‐term RCTs are needed to clarify the role of statins as disease‐modifying therapy in cirrhosis.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"94 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Amino acid imbalance, characterised by decreased branched-chain amino acids (BCAAs) and increased tyrosine levels, is a common metabolic disturbance associated with various complications in patients with cirrhosis. However, the independent prognostic value of these changes remains unclear.
Aims: This study aimed to elucidate the prognostic impact of amino acid imbalance by analysing BCAA and tyrosine levels in patients with cirrhosis.
Methods: This multicenter retrospective study reviewed patients hospitalised for cirrhosis in Gifu, Japan. Amino acid imbalance was evaluated using serum BCAA and tyrosine levels and the BCAA-to-tyrosine ratio (BTR). Prognosis was assessed using a Cox proportional hazards regression model. Multivariable analyses were conducted using a model that included BTR, which was then replaced with both BCAA and tyrosine levels.
Results: Amongst 541 patients (median age, 66 years; 50.3% female), 129 (23.8%) died during a median follow-up of 3.5 years. The median BTR, serum BCAA and tyrosine levels were 4.36, 378 and 90 μmol/L, respectively. Multivariable analysis identified BTR (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.72-0.94; p = 0.004) as a significant prognostic factor after adjustment for established factors. In the subsequent model, both BCAA (HR, 1.00; 95% CI, 1.00-1.00; p = 0.019) and tyrosine levels (HR, 1.01; 95% CI, 1.00-1.01; p = 0.002) independently predicted mortality.
Conclusions: Amino acid imbalance is an independent factor for poor prognosis in patients with cirrhosis. Notably, decreased BCAA and increased tyrosine levels were identified as independent prognostic factors.
背景：以支链氨基酸（BCAAs）减少和酪氨酸水平升高为特征的氨基酸失衡是肝硬化患者常见的代谢紊乱，与各种并发症相关。然而，这些变化的独立预后价值尚不清楚。目的：本研究旨在通过分析肝硬化患者BCAA和酪氨酸水平来阐明氨基酸失衡对预后的影响。方法：这项多中心回顾性研究回顾了日本岐阜因肝硬化住院的患者。利用血清BCAA和酪氨酸水平以及BCAA与酪氨酸比值（BTR）评估氨基酸失衡。采用Cox比例风险回归模型评估预后。使用包括BTR在内的模型进行多变量分析，然后用BCAA和酪氨酸水平代替BTR。结果：在541例患者中（中位年龄66岁，50.3%为女性），129例（23.8%）在中位3.5年随访期间死亡。BTR、血清BCAA和酪氨酸的中位数分别为4.36、378和90 μmol/L。多变量分析发现，在调整既定因素后，BTR（风险比[HR]， 0.82； 95%可信区间[CI]， 0.72-0.94; p = 0.004）是一个重要的预后因素。在随后的模型中，BCAA （HR, 1.00; 95% CI, 1.00-1.00; p = 0.019）和酪氨酸水平（HR, 1.01; 95% CI, 1.00-1.01; p = 0.002）独立预测死亡率。结论：氨基酸失衡是肝硬化患者预后不良的独立因素。值得注意的是，BCAA下降和酪氨酸水平升高被确定为独立的预后因素。
{"title":"Amino Acid Imbalance Is an Independent Factor for Mortality in Patients With Liver Cirrhosis.","authors":"Yuki Utakata, Takao Miwa, Shinji Unome, Naoya Masuda, Mikita Oi, Masashi Aiba, Kenji Imai, Koji Takai, Makoto Shiraki, Naoki Katsumura, Masahito Shimizu","doi":"10.1111/apt.70525","DOIUrl":"https://doi.org/10.1111/apt.70525","url":null,"abstract":"<p><strong>Background: </strong>Amino acid imbalance, characterised by decreased branched-chain amino acids (BCAAs) and increased tyrosine levels, is a common metabolic disturbance associated with various complications in patients with cirrhosis. However, the independent prognostic value of these changes remains unclear.</p><p><strong>Aims: </strong>This study aimed to elucidate the prognostic impact of amino acid imbalance by analysing BCAA and tyrosine levels in patients with cirrhosis.</p><p><strong>Methods: </strong>This multicenter retrospective study reviewed patients hospitalised for cirrhosis in Gifu, Japan. Amino acid imbalance was evaluated using serum BCAA and tyrosine levels and the BCAA-to-tyrosine ratio (BTR). Prognosis was assessed using a Cox proportional hazards regression model. Multivariable analyses were conducted using a model that included BTR, which was then replaced with both BCAA and tyrosine levels.</p><p><strong>Results: </strong>Amongst 541 patients (median age, 66 years; 50.3% female), 129 (23.8%) died during a median follow-up of 3.5 years. The median BTR, serum BCAA and tyrosine levels were 4.36, 378 and 90 μmol/L, respectively. Multivariable analysis identified BTR (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.72-0.94; p = 0.004) as a significant prognostic factor after adjustment for established factors. In the subsequent model, both BCAA (HR, 1.00; 95% CI, 1.00-1.00; p = 0.019) and tyrosine levels (HR, 1.01; 95% CI, 1.00-1.01; p = 0.002) independently predicted mortality.</p><p><strong>Conclusions: </strong>Amino acid imbalance is an independent factor for poor prognosis in patients with cirrhosis. Notably, decreased BCAA and increased tyrosine levels were identified as independent prognostic factors.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdel-Aziz Shaheen,Meng Wang,Bryce Tkachuk,Juan G Abraldes
BACKGROUND AND AIMSRandomised trials such as the STOPAH trial questioned the efficacy of pentoxifylline (PTX) and provided mixed evidence for corticosteroids (CS) in alcohol-associated hepatitis (AH). We aimed to assess temporal trends in the use of PTX and CS in Alberta and to evaluate the real-world effectiveness of CS using a target trial emulation approach.APPROACH AND RESULTSWe conducted a population-based cohort study using linked administrative, laboratory and pharmaceutical data from Alberta, Canada. Adults hospitalised with AH between 2012 and 2023 who met National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria were included. Joinpoint regression evaluated changes in medication use and mortality trends. A sequence of emulated target trials estimated the effect of initiating CS within 7 days on 30- and 90-day mortality. Among 2706 admissions (2138 patients), PTX use declined sharply after 2014 and was nearly absent after 2016. CS use increased modestly during the same period. Thirty-day mortality decreased gradually after 2016, while 90-day mortality remained stable. In 1365 patients with MELD ≥ 20, CS use was associated with a non-significant 2% absolute reduction in 30-day mortality (hazard ratio, 0.86; 95% CI, 0.73-1.03), with no effect at 90 days. No benefit was observed in patients with MELD > 35.CONCLUSIONSRCT evidence led to a rapid reversal in PTX prescribing prior to formal guideline updates. Real-world data support a modest short-term benefit of CS and illustrate the potential of target trial emulation to assess treatment effectiveness in specific groups of patients.
{"title":"Impact of Evolving Evidence on Pharmacological Therapy for Alcohol-Associated Hepatitis in Alberta: A Population-Based Study of Practice Trends and MELD-Stratified Effectiveness of Corticosteroids.","authors":"Abdel-Aziz Shaheen,Meng Wang,Bryce Tkachuk,Juan G Abraldes","doi":"10.1111/apt.70517","DOIUrl":"https://doi.org/10.1111/apt.70517","url":null,"abstract":"BACKGROUND AND AIMSRandomised trials such as the STOPAH trial questioned the efficacy of pentoxifylline (PTX) and provided mixed evidence for corticosteroids (CS) in alcohol-associated hepatitis (AH). We aimed to assess temporal trends in the use of PTX and CS in Alberta and to evaluate the real-world effectiveness of CS using a target trial emulation approach.APPROACH AND RESULTSWe conducted a population-based cohort study using linked administrative, laboratory and pharmaceutical data from Alberta, Canada. Adults hospitalised with AH between 2012 and 2023 who met National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria were included. Joinpoint regression evaluated changes in medication use and mortality trends. A sequence of emulated target trials estimated the effect of initiating CS within 7 days on 30- and 90-day mortality. Among 2706 admissions (2138 patients), PTX use declined sharply after 2014 and was nearly absent after 2016. CS use increased modestly during the same period. Thirty-day mortality decreased gradually after 2016, while 90-day mortality remained stable. In 1365 patients with MELD ≥ 20, CS use was associated with a non-significant 2% absolute reduction in 30-day mortality (hazard ratio, 0.86; 95% CI, 0.73-1.03), with no effect at 90 days. No benefit was observed in patients with MELD > 35.CONCLUSIONSRCT evidence led to a rapid reversal in PTX prescribing prior to formal guideline updates. Real-world data support a modest short-term benefit of CS and illustrate the potential of target trial emulation to assess treatment effectiveness in specific groups of patients.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"11 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND & AIMSThe diagnosis and follow-up of eosinophilic oesophagitis (EoE) currently rely on repeated upper endoscopies (EGD) with biopsies, which are invasive, resource-intensive and environmentally costly. Non-invasive biomarkers for EoE are needed. We investigated the role of blood eosinophils and lymphocytes in the management of EoE.METHODSThis was a prospective study conducted at four EoE referral centres. Consecutive adults undergoing EGD with biopsies for known or suspected EoE were enrolled. Based on oesophageal peak eosinophil count (PEC) and clinical history, patients were divided into EoE (histologically active or in remission) and non-EoE dysphagia (NED). Prior to the EGD, a full blood count was obtained. Clinical, endoscopic and histologic findings were recorded. Receiver operating characteristic curve analysis was used to assess the predictive ability of blood biomarkers (AUC).RESULTSWe enrolled 209 patients (123 EoE and 86 NED). For the diagnosis of EoE, an absolute eosinophil count (AEC) of 155 eosinophils/mm3 had an AUC of 85%. For the assessment of histological disease activity, an AEC of 325 eosinophils/mm3 had an AUC of 70.5% for the identification of histological remission following treatment. AEC showed a positive correlation with PEC on histology and the EoE endoscopic reference score with Spearman's Rho of 0.4 (p < 0.0001).CONCLUSIONEosinophil absolute and relative counts in the peripheral blood could be used in the initial assessment of patients presenting with dysphagia to accurately differentiate EoE from NED and to predict histological remission of EoE.
{"title":"Blood Eosinophils Are Accurate Biomarkers for the Management of Eosinophilic Oesophagitis: Prospective, Multi-Centre Study.","authors":"Pierfrancesco Visaggi,Gaia Pellegatta,Stefano Siboni,Daria Maniero,Giulio Del Corso,Irene Solinas,Mauro Mitilini,Federico Testi,Gaia Cairoli,Isabella Dulmin,Valeria Poletti,Giacomo Marcozzi,Marco Sozzi,Lucia Piazza,Delio Stefani Donati,Massimo Bellini,Alessandro Repici,Edoardo Vincenzo Savarino,Nicola de Bortoli","doi":"10.1111/apt.70524","DOIUrl":"https://doi.org/10.1111/apt.70524","url":null,"abstract":"BACKGROUND & AIMSThe diagnosis and follow-up of eosinophilic oesophagitis (EoE) currently rely on repeated upper endoscopies (EGD) with biopsies, which are invasive, resource-intensive and environmentally costly. Non-invasive biomarkers for EoE are needed. We investigated the role of blood eosinophils and lymphocytes in the management of EoE.METHODSThis was a prospective study conducted at four EoE referral centres. Consecutive adults undergoing EGD with biopsies for known or suspected EoE were enrolled. Based on oesophageal peak eosinophil count (PEC) and clinical history, patients were divided into EoE (histologically active or in remission) and non-EoE dysphagia (NED). Prior to the EGD, a full blood count was obtained. Clinical, endoscopic and histologic findings were recorded. Receiver operating characteristic curve analysis was used to assess the predictive ability of blood biomarkers (AUC).RESULTSWe enrolled 209 patients (123 EoE and 86 NED). For the diagnosis of EoE, an absolute eosinophil count (AEC) of 155 eosinophils/mm3 had an AUC of 85%. For the assessment of histological disease activity, an AEC of 325 eosinophils/mm3 had an AUC of 70.5% for the identification of histological remission following treatment. AEC showed a positive correlation with PEC on histology and the EoE endoscopic reference score with Spearman's Rho of 0.4 (p < 0.0001).CONCLUSIONEosinophil absolute and relative counts in the peripheral blood could be used in the initial assessment of patients presenting with dysphagia to accurately differentiate EoE from NED and to predict histological remission of EoE.","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"5 1","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial: Decoding Gut Failure in Cirrhosis-Villin-1 and the Emergence of a Seventh Organ Failure. Authors' Reply.","authors":"David Tornai, Maria Papp","doi":"10.1111/apt.70529","DOIUrl":"https://doi.org/10.1111/apt.70529","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial: Decoding Gut Failure in Cirrhosis: Villin-1 and the Emergence of a Seventh Organ Failure.","authors":"Nipun Verma, Pragyan Acharya","doi":"10.1111/apt.70501","DOIUrl":"https://doi.org/10.1111/apt.70501","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ankit Kumar, Amol N Patil, Jyoti Grewal, J Kumaravel, Muhammad Aaqib Shamim, Aravind Sekar, Anuraag Jena, Anupam K Singh, Ashish Kakkar, Usha Dutta, Vishal Sharma
Background: Appropriate tapering strategy for corticosteroids in ulcerative colitis (UC) is uncertain.
Aim: To compare the efficacy and safety of two steroid tapering regimens in patients with active UC.
Methods: We randomised patients with active UC with initial steroid response after 2 weeks to short (total 6 weeks) or long taper (total 10 weeks). Randomization was stratified for acute severe UC. The primary outcome was steroid-free clinical remission at 6 months. Secondary outcomes included assessment of symptomatic remission, relapse rate, endoscopic and histological scores, and safety.
Results: Of 94 patients (48 in long, 46 in short taper) randomised, short taper was inferior to long taper in inducing clinical remission at 6 months (RR = 2.19; CI 1.08-4.46; p = 0.02). The relapse rates were similar in the long (37%) and short taper (46%) arms (HR: 0.34; CI: 0.10-1.11; p = 0.42). The median UCEIS scores (3 vs. 2; p = 0.23) and Nancy scores [2 (IQR 0-3) vs. 1.5 (0.75-3); p = 0.4] were not different between arms. Adverse events in the long and short taper arms, such as acne (14.58% vs. 2.16%), myopathy (8.33% vs. 6.52%), skin changes (2.08% vs. 2.17%), mood changes (0% vs. 4.34%), cytopenia (0% vs. 2.17%), and headache (6.25% vs. 6.52%) were similar.
Conclusion: A shorter taper duration of 6 weeks was inferior to a longer taper of 10 weeks in achieving clinical remission of UC at 6 months.
背景：在溃疡性结肠炎（UC）中适当的糖皮质激素减量策略尚不确定。目的：比较两种类固醇减量治疗活动性UC患者的疗效和安全性。方法：我们将2周后出现初始类固醇反应的活动性UC患者随机分为短（共6周）或长（共10周）。对急性重症UC进行随机分层。主要结局是6个月时无类固醇临床缓解。次要结局包括评估症状缓解、复发率、内镜和组织学评分以及安全性。结果：94例随机分组患者（48例长锥度，46例短锥度）中，短锥度在6个月时诱导临床缓解的效果不如长锥度（RR = 2.19; CI 1.08-4.46; p = 0.02）。复发率在长（37%）和短（46%）组相似（HR: 0.34; CI: 0.10-1.11; p = 0.42）。中位UCEIS评分（3比2，p = 0.23）和Nancy评分[2 （IQR 0-3）比1.5 (0.75-3)；P = 0.4]两组间差异无统计学意义。长短锥度臂的不良事件，如痤疮（14.58% vs. 2.16%）、肌病（8.33% vs. 6.52%）、皮肤变化（2.08% vs. 2.17%）、情绪变化（0% vs. 4.34%）、细胞减少（0% vs. 2.17%）和头痛（6.25% vs. 6.52%）相似。结论：在6个月时实现UC临床缓解时，较短的6周逐渐减少时间不如较长的10周逐渐减少时间。试验报名：CTRI编号：CTRI/2021/06/034129。
{"title":"Clinical Trial: Long Versus Short Tapering of Steroids in Steroid Responsive Moderate to Severely Active Ulcerative Colitis-A Randomised Controlled Trial.","authors":"Ankit Kumar, Amol N Patil, Jyoti Grewal, J Kumaravel, Muhammad Aaqib Shamim, Aravind Sekar, Anuraag Jena, Anupam K Singh, Ashish Kakkar, Usha Dutta, Vishal Sharma","doi":"10.1111/apt.70509","DOIUrl":"https://doi.org/10.1111/apt.70509","url":null,"abstract":"<p><strong>Background: </strong>Appropriate tapering strategy for corticosteroids in ulcerative colitis (UC) is uncertain.</p><p><strong>Aim: </strong>To compare the efficacy and safety of two steroid tapering regimens in patients with active UC.</p><p><strong>Methods: </strong>We randomised patients with active UC with initial steroid response after 2 weeks to short (total 6 weeks) or long taper (total 10 weeks). Randomization was stratified for acute severe UC. The primary outcome was steroid-free clinical remission at 6 months. Secondary outcomes included assessment of symptomatic remission, relapse rate, endoscopic and histological scores, and safety.</p><p><strong>Results: </strong>Of 94 patients (48 in long, 46 in short taper) randomised, short taper was inferior to long taper in inducing clinical remission at 6 months (RR = 2.19; CI 1.08-4.46; p = 0.02). The relapse rates were similar in the long (37%) and short taper (46%) arms (HR: 0.34; CI: 0.10-1.11; p = 0.42). The median UCEIS scores (3 vs. 2; p = 0.23) and Nancy scores [2 (IQR 0-3) vs. 1.5 (0.75-3); p = 0.4] were not different between arms. Adverse events in the long and short taper arms, such as acne (14.58% vs. 2.16%), myopathy (8.33% vs. 6.52%), skin changes (2.08% vs. 2.17%), mood changes (0% vs. 4.34%), cytopenia (0% vs. 2.17%), and headache (6.25% vs. 6.52%) were similar.</p><p><strong>Conclusion: </strong>A shorter taper duration of 6 weeks was inferior to a longer taper of 10 weeks in achieving clinical remission of UC at 6 months.</p><p><strong>Trial registration: </strong>CTRI Number: CTRI/2021/06/034129.</p>","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>We read with great interest the study by Heo et al. which revealed that the tumour recurrence associated with the baseline viral replication activity in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients who underwent hepatectomy varied according to cirrhosis status [<span>1</span>]. Notably, patients who underwent liver transplantation were not included in this study; thus, the association between the HCC recurrence and the baseline viral replication activity for these individuals remains unclear.</p><p>Liver transplantation stands as the optimal curative treatment for HCC patients [<span>2</span>]. However, tumour recurrence significantly compromises the efficacy of the operation [<span>3, 4</span>]. Our previous studies have identified HBV reactivation following liver transplantation as a critical risk factor for post-transplant tumour recurrence of HCC patients [<span>5-7</span>]. Here, we conducted a retrospective analysis of our cohort (NCT06114251), which included 462 patients with HBV-related HCC. Our aim was to explore the association between baseline viral replication activity and both HCC recurrence and HBV reactivation in these individuals with cirrhotic status.</p><p>Among the 462 HBV-related HCC patients, 211 (45.7%) had detectable HBV-DNA prior to transplantation, while 431 (93.3%) had cirrhosis. The cumulative HCC recurrence rates at 1, 2, and 5 years were 23.6%, 32.3%, and 36.0%, respectively. The cumulative HBV reactivation rates at 1, 2, and 5 years were 12.3%, 15.5%, and 17.8%, respectively. Antiviral therapy with nucleotide analogues was routinely administered after the diagnosis of HBV infection prior to surgery. However, some patients were unaware of their HBV infection until HCC was diagnosed and thus may not have received adequate antiviral treatment before transplantation. Other baseline characteristics of these patients can be found in our previous research [<span>5</span>].</p><p>In cirrhotic patients, HCC recurrence risk showed a non-linear association with baseline HBV DNA, peaking at 2–4 log<sub>10</sub> IU/mL. Compared to the non-detectable (ND) HBV DNA group, the adjusted HR was 1.72 (95% CI, 1.07–2.77; <i>p</i> = 0.025) for the 2–3 log<sub>10</sub> IU/mL group and 1.73 (95% CI, 1.03–2.95; <i>p</i> = 0.038) for the 3–4 log<sub>10</sub> IU/mL group. Risks at levels ≥ 4 log<sub>10</sub> IU/mL were non-significant (Figure 1A). A similar pattern was observed for HBV reactivation risk, which was elevated at 2–3 log<sub>10</sub> IU/mL (adjusted HR, 2.30; 95% CI, 1.23–4.31; <i>p</i> = 0.009) but lower at ≥ 4 log<sub>10</sub> IU/mL (Figure 1B).</p><p>Our analysis confirms a non-linear association between baseline HBV DNA levels and the risks of HCC recurrence or HBV reactivation after transplantation in cirrhotic patients. This result is inconsistent with that reported by Heo et al. The discrepancy may be attributed to some factors. First, the cohort in Heo et al. exclusively comprised BCLC 0-A pat
{"title":"Letter: Association Between Viral Replication Activity and Post-Transplant Recurrence of HBV-Related Hepatocellular Carcinoma","authors":"Huigang Li, Ruijie Zhao, Jinyan Chen, Shusen Zheng, Di Lu, Xiao Xu","doi":"10.1111/apt.70514","DOIUrl":"10.1111/apt.70514","url":null,"abstract":"<p>We read with great interest the study by Heo et al. which revealed that the tumour recurrence associated with the baseline viral replication activity in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients who underwent hepatectomy varied according to cirrhosis status [<span>1</span>]. Notably, patients who underwent liver transplantation were not included in this study; thus, the association between the HCC recurrence and the baseline viral replication activity for these individuals remains unclear.</p><p>Liver transplantation stands as the optimal curative treatment for HCC patients [<span>2</span>]. However, tumour recurrence significantly compromises the efficacy of the operation [<span>3, 4</span>]. Our previous studies have identified HBV reactivation following liver transplantation as a critical risk factor for post-transplant tumour recurrence of HCC patients [<span>5-7</span>]. Here, we conducted a retrospective analysis of our cohort (NCT06114251), which included 462 patients with HBV-related HCC. Our aim was to explore the association between baseline viral replication activity and both HCC recurrence and HBV reactivation in these individuals with cirrhotic status.</p><p>Among the 462 HBV-related HCC patients, 211 (45.7%) had detectable HBV-DNA prior to transplantation, while 431 (93.3%) had cirrhosis. The cumulative HCC recurrence rates at 1, 2, and 5 years were 23.6%, 32.3%, and 36.0%, respectively. The cumulative HBV reactivation rates at 1, 2, and 5 years were 12.3%, 15.5%, and 17.8%, respectively. Antiviral therapy with nucleotide analogues was routinely administered after the diagnosis of HBV infection prior to surgery. However, some patients were unaware of their HBV infection until HCC was diagnosed and thus may not have received adequate antiviral treatment before transplantation. Other baseline characteristics of these patients can be found in our previous research [<span>5</span>].</p><p>In cirrhotic patients, HCC recurrence risk showed a non-linear association with baseline HBV DNA, peaking at 2–4 log<sub>10</sub> IU/mL. Compared to the non-detectable (ND) HBV DNA group, the adjusted HR was 1.72 (95% CI, 1.07–2.77; <i>p</i> = 0.025) for the 2–3 log<sub>10</sub> IU/mL group and 1.73 (95% CI, 1.03–2.95; <i>p</i> = 0.038) for the 3–4 log<sub>10</sub> IU/mL group. Risks at levels ≥ 4 log<sub>10</sub> IU/mL were non-significant (Figure 1A). A similar pattern was observed for HBV reactivation risk, which was elevated at 2–3 log<sub>10</sub> IU/mL (adjusted HR, 2.30; 95% CI, 1.23–4.31; <i>p</i> = 0.009) but lower at ≥ 4 log<sub>10</sub> IU/mL (Figure 1B).</p><p>Our analysis confirms a non-linear association between baseline HBV DNA levels and the risks of HCC recurrence or HBV reactivation after transplantation in cirrhotic patients. This result is inconsistent with that reported by Heo et al. The discrepancy may be attributed to some factors. First, the cohort in Heo et al. exclusively comprised BCLC 0-A pat","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":"63 4","pages":"584-586"},"PeriodicalIF":6.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.70514","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial: Dysfunctional Neutrophils in Cirrhosis With Acute Decompensation: Why It Matters.","authors":"L L Gluud, N Kimer","doi":"10.1111/apt.70502","DOIUrl":"https://doi.org/10.1111/apt.70502","url":null,"abstract":"","PeriodicalId":121,"journal":{"name":"Alimentary Pharmacology & Therapeutics","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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