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Dig Liver Dis. 2018 Oct 12. pii: S1590-8658(18)31178-2. doi: 10.1016/j.dld.2018.10.004. [Epub ahead of print]

Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapy with prednisolone and azathioprine.

Author information

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
Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. Electronic address: sven.almer@ki.se.

Abstract

BACKGROUND:

Data on rescue treatment of autoimmune hepatitis in patients that fail standard treatment are sparse.

AIMS:

To report our long-term experience with mycophenolate mofetil.

METHODS:

Retrospective 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%).

RESULTS:

Mycophenolate 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levels were obtained (n = 3) or maintained (n = 7) in 10 patients (45%) after three to 30 weeks. 12 patients (55%) were withdrawn during the first 6 months, due to adverse events.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.

CONCLUSION:

Approximately 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.

KEYWORDS:

Autoimmune hepatitis; Mycophenolate mofetil; Thiopurine failure

PMID:
30389427
DOI:
10.1016/j.dld.2018.10.004

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