Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapy with prednisolone and azathioprine |
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Authors: | Georgios Giannakopoulos Hans Verbaan Inga-Lill Friis-Liby Per Sangfelt Nils Nyhlin Sven Almer |
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Affiliation: | 1. Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden;2. Department of Medicine, Skåne University Hospital, Malmö, Sweden;3. Department of Medicine, Sahlgren’s University Hospital, Göteborg, Sweden;4. Department of Medicine, Akademiska Hospital, Uppsala, Sweden;5. Department of Medicine, Örebro University Hospital, Örebro, Sweden;6. Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden |
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Abstract: | BackgroundData on rescue treatment of autoimmune hepatitis in patients that fail standard treatment are sparse.AimsTo report our long-term experience with mycophenolate mofetil.MethodsRetrospective study in 22 patients with autoimmune hepatitis who failed azathioprine and prednisolone due to adverse events (n?=?14, 64%), lack of remission (n?=?5, 23%) or a combination (n?=?3, 13%).ResultsMycophenolate mofetil was started at a dose of 20?mg/kg/day and increased to a maximum of 3?g/day. Follow-up was 0–6 months in 7 patients; more than 12 months in 15 (68%) and more than 24 months in 10. Normal aminotransferase levels were obtained (n?=?3) or maintained (n?=?7) in 10 patients (45%) after three to 30 weeks. 12 patients (55%) were withdrawn during the first 6 months, due to adverse events. Three patients were switched to cyclosporine and one underwent liver transplantation. Successful treatment with mycophenolate mofetil continued in 10 patients (45%) for a median of 71 months (range 20–124). Of these, one stopped prednisolone, five have a prednisolone dose <5?mg daily and four patients 5–10?mg.ConclusionApproximately one of two patients with autoimmune hepatitis that fail standard treatment benefit from long-term maintenance with mycophenolate mofetil, especially those with previous intolerance to thiopurines, where mycophenolate mofetil is effective in two thirds. |
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Keywords: | Autoimmune hepatitis Mycophenolate mofetil Thiopurine failure |
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