Mycophenolate mofetil as second line treatment in autoimmune hepatitis - A retrospective single center analysis.
AIH, autoimmune hepatitis
ALT, alanine aminotransferase
ANA, anti-nuclear-antibodies
AZA, azathioprine
Autoimmune hepatitis
Autoimmune liver disease
Azathioprine
BDN, budesonide
CI, calcineurin inhibitor
CyA, cylcosporine A
INR, international normalized ratio
IQR, interquartile range
IgG, immunoglobuline G
LKM-1, liver-kidney-microsomal antibodies
MMF, mycophenolate mofetil
Mycophenolate mofetil
PBC, primary biliary cholangitis
PDN, prednisolone
PSC, primary sclerosing cholangitis
SLA, soluble liver antigen antibodies
SMA, smooth-muscle cell antibodies
Second line treatment
TNFi, tumor necrosis factor inhibitor
UDCA, ursodeoxycholic acid
ULN, upper limit of normal
Journal
Journal of translational autoimmunity
ISSN: 2589-9090
Titre abrégé: J Transl Autoimmun
Pays: Netherlands
ID NLM: 101759413
Informations de publication
Date de publication:
2022
2022
Historique:
received:
16
11
2022
accepted:
16
11
2022
entrez:
1
12
2022
pubmed:
2
12
2022
medline:
2
12
2022
Statut:
epublish
Résumé
Most patients with autoimmune hepatitis respond to standard treatment with steroids and azathioprine. While the disease is usually fatal if untreated, patients who respond well to therapy have an excellent prognosis. Nevertheless, second-line treatment is necessary in approximately 20% of patients, due to either intolerance or insufficient response to first line treatment.While data for mycophenolate mofetil (MMF) in patients intolerant to azathioprine is encouraging, MMF seems of less benefit in patients with insufficient response to first line treatment, but analyzed data on this issue is limited. To evaluate the efficacy and safety of MMF as a second-line therapy in patients with AIH. Retrospective analysis of a monocentric database of AIH patients who received medical care from 2000 to 2022. Clinical, immunological and biochemical parameters were assessed at different time points including last follow-up. Overall, 144 patients with AIH were identified. Fifty out of 144 (35%) AIH patients received MMF. Forty (80%) received MMF due to first line treatment intolerance, while ten (20%) due to insufficient response to first line treatment.Remission with MMF monotherapy was 81.5% in the intolerance group versus 30% in the insufficient response group. Patients switched to MMF because of an insufficient response, more often needed additional prednisolone doses higher than 5 mg/day, a switch to third-line treatment or combination regiments, to achieve disease control. Patients treated with MMF because of intolerance to first line treatment show a good disease control under MMF in the majority of cases. Efficacy is considerably lower in the patients switched to MMF because of an insufficient response to first line treatment.
Sections du résumé
Background
UNASSIGNED
Most patients with autoimmune hepatitis respond to standard treatment with steroids and azathioprine. While the disease is usually fatal if untreated, patients who respond well to therapy have an excellent prognosis. Nevertheless, second-line treatment is necessary in approximately 20% of patients, due to either intolerance or insufficient response to first line treatment.While data for mycophenolate mofetil (MMF) in patients intolerant to azathioprine is encouraging, MMF seems of less benefit in patients with insufficient response to first line treatment, but analyzed data on this issue is limited.
Aim
UNASSIGNED
To evaluate the efficacy and safety of MMF as a second-line therapy in patients with AIH.
Methods
UNASSIGNED
Retrospective analysis of a monocentric database of AIH patients who received medical care from 2000 to 2022. Clinical, immunological and biochemical parameters were assessed at different time points including last follow-up.
Results
UNASSIGNED
Overall, 144 patients with AIH were identified. Fifty out of 144 (35%) AIH patients received MMF. Forty (80%) received MMF due to first line treatment intolerance, while ten (20%) due to insufficient response to first line treatment.Remission with MMF monotherapy was 81.5% in the intolerance group versus 30% in the insufficient response group. Patients switched to MMF because of an insufficient response, more often needed additional prednisolone doses higher than 5 mg/day, a switch to third-line treatment or combination regiments, to achieve disease control.
Conclusions
UNASSIGNED
Patients treated with MMF because of intolerance to first line treatment show a good disease control under MMF in the majority of cases. Efficacy is considerably lower in the patients switched to MMF because of an insufficient response to first line treatment.
Identifiants
pubmed: 36451933
doi: 10.1016/j.jtauto.2022.100172
pii: S2589-9090(22)00033-8
pmc: PMC9702977
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100172Informations de copyright
© 2022 The Authors.
Déclaration de conflit d'intérêts
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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