A Case of Cyclosporine-Sensitive, Steroid-Resistant, Autoimmune Chronic Active Hepatitis

Person, John L.; McHutchison, John G.; Fong, Tse‐Ling; Redeker, Allan G.

doi:10.1097/00004836-199312000-00012

Cited by 46 publications

(18 citation statements)

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“…However a common pattern observed in the published data to date is the rapid recurrence of disease on dose reduction or cessation of this agent [8,31,32]. …”

Section: Other Agentsmentioning

confidence: 99%

The use of immunosuppression in autoimmune hepatitis: A current literature review

Cropley

Weltman

2017

Clin Mol Hepatol

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Autoimmune hepatitis (AIH) is an organ specific autoimmune condition which can manifest at any age of life. The heterogeneous nature of this condition means that great variation can be seen in severity, progression of disease and response to treatment within this patient group. Since the 1980s prednisolone and azathioprine have been used for induction and remission of the disease and remain the mainstay of treatment. Other immunosuppressive agents have been employed in difficult to treat cases. While there is less published data regarding these agents compared with the conventional treatments of steroid and azathioprine, there is mounting evidence to support the use of mycophenolate mofetil as a second-line agent. The calcineurin inhibitors, though less studied, additionally show promise. More data is needed on the use of biological agents in refractory disease. This review focuses on our centre’s approach to treatment of AIH in the context of a contemporary review of the literature.

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“…However a common pattern observed in the published data to date is the rapid recurrence of disease on dose reduction or cessation of this agent [8,31,32]. …”

Section: Other Agentsmentioning

confidence: 99%

The use of immunosuppression in autoimmune hepatitis: A current literature review

Cropley

Weltman

2017

Clin Mol Hepatol

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“…In dosages of 5-6 mg/kg daily, it has been used successfully as 'salvage' therapy in patients who have failed or have been intolerant of conventional corticosteroid therapy, and it has also been used as first-line therapy. [83][84][85][86][87][88][89] Ciclosporin was first used in 1985, in a 51-year-old man with 5-year history of autoimmune hepatitis refractory to corticosteroid therapy. Presenting symptoms improved for the first time since the onset of his illness, liver enzyme levels fell to near-normal values and virtually no side effects were experienced.…”

Section: Ciclosporinmentioning

confidence: 99%

“…83 Since 1985, other single case reports of patients who failed treatment with corticosteroids but responded well to treatment with ciclosporin have been described. [84][85][86] Sherman et al…”

Section: Ciclosporinmentioning

confidence: 99%

Systematic review: managing suboptimal treatment responses in autoimmune hepatitis with conventional and nonstandard drugs

Selvarajah

Montano‐Loza

Czaja

2012

Aliment Pharmacol Ther

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“…Ten single-center experiences with cyclosporine published over the past 27 years have involved 133 patients, and they have documented improvement in 93% and treatment failure, defined as no response, non-compliance or drug intolerance, in only 7% [65,143,144,[149][150][151][152][153][154][155]. Three single-center experiences with tacrolimus published over the past 17 years have shown similar outcomes in 41 patients.…”

Section: Calcineurin Inhibitorsmentioning

confidence: 99%

Nonstandard Drugs and Feasible New Interventions for Autoimmune Hepatitis: Part I

Czaja¹

2012

IADT

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Nonstandard drugs that target critical pathogenic pathways or immune regulatory mechanisms constitute the next generation of treatments for autoimmune hepatitis. Mycophenolate mofetil impairs the proliferation of lymphocytes, decreases autoantibody production, and induces apoptosis of activated immunocytes. Patients treated for azathioprine intolerance improve more frequently than patients treated for refractory liver disease (54% versus 10%), and mycophenolate mofetil is emerging as a rescue therapy for this population. Complete corticosteroid withdrawal is possible in 40% of patients treated with mycophenolate mofetil, and the frequency of side effects ranges from 3-34%. Budesonide in combination with azathioprine has normalized liver tests more frequently (47% versus 18%) and with fewer side effects (28% versus 53%) than standard therapy after 6 months. Budesonide is emerging as a frontline treatment in non-cirrhotic patients with uncomplicated disease or contraindications to conventional corticosteroids. Cyclosporine and tacrolimus are effective salvage agents for steroid-refractory disease, but side effects have been common and occasionally serious. The 6- thioguanine nucleotides and rapamycin are feasible treatments for autoimmune hepatitis, but 6-thioguanine has major obstacles to overcome, especially the risk of liver toxicity or nodular regenerative hyperplasia. The nonstandard drug therapies emerging for autoimmune hepatitis reflect the need to supplement or supplant current treatment regimens. None has been licensed for use in autoimmune hepatitis, and their applications have been based on results from small singlecenter experiences.

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A Case of Cyclosporine-Sensitive, Steroid-Resistant, Autoimmune Chronic Active Hepatitis

Cited by 46 publications

References 0 publications

The use of immunosuppression in autoimmune hepatitis: A current literature review

The use of immunosuppression in autoimmune hepatitis: A current literature review

Systematic review: managing suboptimal treatment responses in autoimmune hepatitis with conventional and nonstandard drugs

Nonstandard Drugs and Feasible New Interventions for Autoimmune Hepatitis: Part I

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