Editorial: autoimmune hepatitis – identifying options for treatment

Janmohamed, Ashnila; Hirschfield, Gideon M.

doi:10.1111/apt.13607

Cited by 4 publications

(2 citation statements)

References 12 publications

(18 reference statements)

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“…Our study has shown that only 60% of patients receiving MMF as second‐line therapy achieve complete remission, highlighting the importance of identifying the best candidates and looking at possible other agents such as calcineurin inhibitors where necessary. This point was emphasised in a recent article by Janmohamed et al who stressed the importance of intensifying efforts towards identifying patients at greatest risk of treatment failure in order to provide rational personalised management for AIH patients at greatest risk of a poor outcome …”

Section: Discussionmentioning

confidence: 99%

Beneficial response to mycophenolate mofetil by patients with autoimmune hepatitis who have failed standard therapy, is predicted by older age and lower immunoglobulin G and INR levels

Nicoll

Roberts

Lim

et al. 2019

Aliment Pharmacol Ther

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Summary Background Mycophenolate mofetil is a commonly used salvage therapy for patients with autoimmune hepatitis (AIH). Aim To evaluate the predictors of response to mycophenolate rescue therapy to facilitate clinical decision making. Methods We performed a retrospective observational cohort study of AIH patients managed in 17 major Australian liver centres who received mycophenolate after an inadequate response or intolerance to corticosteroids with/without thiopurine(s). Baseline demographic, clinical and laboratory variables were compared between responders and nonresponders. A multivariable logistic regression model was developed using forward selection to identify independent predictors of treatment response. Results A total of 105 patients received mycophenolate rescue therapy of whom 63 (60%) achieved biochemical remission. On univariable analysis, older age (P = 0.003), INR < 1.1 (P = 0.02), and lower immunoglobulin gamma (IgG; P < 0.002) levels were associated with treatment response, while no association was found with cirrhosis status (P = 0.07) or treatment indication (P = 0.63). On multivariable analysis, lower pre‐treatment serum IgG level (P = 0.01), higher age at commencing mycophenolate (P = 0.01) and higher INR (P = 0.03) were the only significant independent predictors. An IgG level <17 g/L had a positive and negative predictive value for response of 71% and 60% respectively, while age ≥54 years when commencing mycophenolate had a positive and negative predictive value for response of 80% and 59% respectively. Conclusion Mycophenolate remains an excellent treatment option for patients with AIH refractory to or intolerant of standard therapy with those most likely to benefit being older and/or having lower pre‐treatment IgG levels.

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