Mindfulness-based stress reduction may decrease stress, disease activity, and inflammatory cytokine levels in patients with autoimmune hepatitis

Author: Leina S Alrabadi1, Anne Dutton2, Anahita Rabiee3, Scott J Roberts3, Yanhong Deng4, Laura Cusack3, Marina G Silveira3, Maria Ciarleglio4, Richard Bucala5, Rajita Sinha2, James L Boyer3, David N Assis3
1 Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology & Nutrition, Stanford University School of Medicine, Palo Alto, CA, USA.
2 Department of Psychiatry and Yale Stress Center, Yale School of Medicine, New Haven, CT, USA.
3 Department of Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA.
4 Yale Center for Analytical Sciences, Yale University School of Public Health Department of Biostatistics, New Haven, CT, USA.
5 Department of Medicine, Section of Rheumatology, Allergy & Immunology, Yale School of Medicine, New Haven, CT, USA.
Conference/Journal: JHEP Rep
Date published: 2022 Feb 18
Other: Volume ID: 4 , Issue ID: 5 , Pages: 100450 , Special Notes: doi: 10.1016/j.jhepr.2022.100450. , Word Count: 407

Background & aims:
Psychological and life stressors may impact autoimmune hepatitis (AIH) disease activity and increase relapse risk. Mindfulness-based stress reduction (MBSR) is a validated course that reduces stress reactivity, and improves stress and emotion regulation. This single-arm exploratory pilot study of adult patients with AIH aimed to define the impact of an 8-week MBSR program on quality of life, disease activity, and cytokine mediators.

The perceived stress survey-10 (PSS) and the brief self-control scale (BSCS) measured subjective distress and self-control. Serum alanine aminotransferase (ALT) and cytokine levels were measured, and immunosuppressant doses recorded.

Seventeen patients completed the MBSR program. Post-MBSR, 71% (n = 12) showed PSS score improvement at 8 weeks vs. baseline (median 15 vs. 21, p = 0.02). At 12 months, PSS improvement persisted vs. baseline (median 15 vs. 21, p = 0.02). Post-MBSR, 71% (n = 12) showed BSCS score improvement at 8 weeks vs. baseline (median 4.1 vs. 3.8, p = 0.03). At 12 months, the median BSCS score remained significant (3.9 vs. 3.8, p = 0.03). After the 8-week MBSR, the 35% of patients with ALT >34 U/L had a median ALT reduction (44.5 vs. 71.5 U/L, p = 0.06), whereas the 71% of patients on prednisone had significant dose reductions (5.75 vs. 10 mg, p = 0.02) which persisted at 12 months vs. baseline (3.75 vs. 10 mg, p = 0.02) without a compensatory increase in steroid-sparing dosing. Significant improvement was noted in peripheral blood cytokine levels (IL-6, IL-8, IL-10, IL-17, IL-23, and sCD74/MIF ratio) from baseline to 8 weeks.

MBSR significantly improved perceived stress and self-control scores while decreasing ALT levels, steroid requirements, and inflammatory cytokine levels in this pilot study in adult AIH. Stress modification may impact quality of life and disease activity, and should be further evaluated as an intervention in AIH.

Clinical trials registration:
This study is registered at ClinicalTrials.gov (NCT02950077).

Lay summary:
Autoimmune hepatitis can reduce quality of life and mental health, while stress may impact autoimmune hepatitis itself. We piloted mindfulness-based stress reduction as a strategy to reduce stress in adult patients with autoimmune hepatitis and found that the intervention reduced perceived stress and may have also impacted the disease by improving inflammation and medication needs. Stress reduction should be further studied to improve quality of life and possibly to impact disease activity in autoimmune hepatitis.

Keywords: AIH, autoimmune hepatitis; ALT, alanine aminotransferase; Autoimmune hepatitis; BSCS, brief self-control scale; Cytokines; MBSR; MBSR, mindfulness-based stress reduction; MIF, macrophage migratory inhibitor factor; PSS, perceived stress scale; Psychological stress; REDCap, research electronic data capture; SRRS, social readjustment rating scale; Stress reduction; ULN, upper limits of normal.

PMID: 35434588 PMCID: PMC9011026 DOI: 10.1016/j.jhepr.2022.100450