Exacerbated autoimmune hepatitis successfully treated with leukocytapheresis and bilirubin adsorption therapy

Sawada, Koji; Ohnishi, Kunio; Kosaka, Toshio; Chikano, Shinji; Egashira, Akimitsu; Okui, Masanori; Shintani, Shigeyuki; Wada, Masaaki; Nakasho, Keiji; Shimoyama, Takashi

doi:10.1007/bf02934123

Cited by 17 publications

(5 citation statements)

References 17 publications

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“…This observation is in agreement with other reports [11,18,21,29]. Adverse reactions related to the extracorporeal nature of the LCAP treatment tend to be transient and mild.…”

Section: Discussionsupporting

confidence: 94%

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Leukocytapheresis (LCAP) in the Management of Chronic Active Ulcerative Colitis—Results of a Randomized Pilot Trial

et al. 2007

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Recent studies suggest that leukocytapheresis with Cellsorba is a valuable therapy for ulcerative colitis after failure of conventional treatment. In this study the potential of leukocytapheresis to induce remission in refractory chronic colitis under the conditions of European treatment guidelines was investigated. The therapeutic benefit of leukocytapheresis in the maintenance of remission was additionally elucidated. Twenty patients were treated weekly for 5 weeks. A significant decrease in the activity index was observed. Fourteen patients achieved clinical remission, and mucosal healing was observed endoscopically in six patients. After randomization these 14 patients in remission entered a second period of either monthly leukocytapheresis or no further treatment. In both groups steroids were tapered down. After 6 months, only one patient in the control group remained in remission, in contrast to five of eight patients in the leukocytapheresis group. In conclusion, leukocytapheresis may offer a therapeutic option in the induction and the maintenance of remission in chronic active ulcerative colitis.

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“…This observation is in agreement with other reports [11,18,21,29]. Adverse reactions related to the extracorporeal nature of the LCAP treatment tend to be transient and mild.…”

Section: Discussionsupporting

confidence: 94%

“…LCAP has also been applied to the treatment of rheumatoid arthritis [13][14][15][16][17], autoimmune hepatitis [18], and Crohn's disease [19]. Based on these reports LCAP is recognized to have an immunomodulatory effect in these autoimmune diseases characterized by a pathogenetic role of cell-mediated immune reactions.…”

Section: Introductionmentioning

confidence: 97%

Leukocytapheresis (LCAP) in the Management of Chronic Active Ulcerative Colitis—Results of a Randomized Pilot Trial

et al. 2007

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“…A systematic review of the published clinical data on pharmacological treatments different from prednisone and azathioprine is provided in this section. Treatments for whom there are only anecdotal data are not discussed cyclophosphamide[ 59 ], methotrexate[ 60 - 62 ], ursodeoxycholic acid[ 63 - 69 ], etanercept[ 70 ], plasma exchange[ 71 ], intravenous immunoglobulin[ 72 ], leukapheresis[ 73 ], chloroquine[ 74 ], thymostimulin[ 75 ], deflazacort[ 76 , 77 ], saireito[ 78 ], sympathomimetic amines[ 79 ], glycyrrhizin[ 80 ], fenofibrate[ 81 ].…”

Section: Alternative Treatmentsmentioning

confidence: 99%

Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments

Beretta‐Piccoli

Mieli‐Vergani

Vergani

2017

WJG

103

102

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Autoimmune hepatitis is a rare chronic inflammatory liver disease, affecting all ages, characterised by elevated transaminase and immunoglobulin G levels, positive autoantibodies, interface hepatitis at liver histology and good response to immunosuppressive treatment. If untreated, it has a poor prognosis. The aim of this review is to summarize the evidence for standard treatment and to provide a systematic review on alternative treatments for adults and children. Standard treatment is based on steroids and azathioprine, and leads to disease remission in 80%-90% of patients. Alternative first line treatment has been attempted with budesonide or cyclosporine, but their superiority compared to standard treatment remains to be demonstrated. Second-line treatments are needed for patients not responding or intolerant to standard treatment. No randomized controlled trials have been performed for second-line options. Mycophenolate mofetil is the most widely used second-line drug, and has good efficacy particularly for patients intolerant to azathioprine, but has the major disadvantage of being teratogenic. Only few and heterogeneous data on cyclosporine, tacrolimus, everolimus and sirolimus are available. More recently, experience with the anti-tumour necrosis factor-alpha infliximab and the anti-CD20 rituximab has been published, with ambivalent results; these agents may have severe side-effects and their use should be restricted to specialized centres. Clinical trials with new therapeutic options are ongoing.

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“…2,3 These patients typically require indefinite therapy, and they remain at risk for drug toxicity and liver failure. The results of empiric treatment with ursodeoxycholic acid, 4 cyclosporine, 5,6 tacrolimus, 7,8 mycophenolate mofetil, [9][10][11][12] cyclophosphamide, 13 methotrexate, 14 rituximab, 15 budesonide, 16 intravenous globulin, 17 or leukocytopheresis 18 attest to the refractory nature of this condition.…”

mentioning

confidence: 99%

Features associated with treatment failure in type 1 autoimmune hepatitis and predictive value of the model of end-stage liver disease

2007

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Autoimmune hepatitis may fail to respond to corticosteroid therapy, but the frequency and bases for this outcome are uncertain. We aimed to determine the frequency and nature of treatment failure in patients with type 1 autoimmune hepatitis, define features associated with its occurrence, and assess if the model for end-stage liver disease can predict this outcome. Patients failing conventional corticosteroid regimens were compared to patients who responded to similar regimens. Fourteen of 214 patients (7%) failed corticosteroid treatment. Patients who failed therapy were younger (33 ؎ 3 years versus 48 ؎ 1 years, P ‫؍‬ 0.0008), had higher serum levels of bilirubin at accession (4.1 ؎ 0.9 mg/dL versus 2.3 ؎ 0.2 mg/dL, P ‫؍‬ 0.02), presented acutely more frequently (43% versus 14%, P ‫؍‬ 0.01), and had a higher frequency of HLA (human leukocyte antigen) DRB1*03 (93% versus 53%, P ‫؍‬ 0.004) than did patients who achieved remission. An alternative disease (fatty liver disease) emerged in only 1 patient who failed therapy (7%). Scores determined by the model of end-stage liver disease at presentation of patients who failed treatment were higher than those of who achieved remission (16 ؎ 1 versus 10 ؎ 0.3 points, P < 0.0001), and score greater than 12 points had greater sensitivity (97%) and specificity (68%) for treatment failure than did HLA DRB1*03 or other features. Conclusion: Onset at an early age, acute presentation, hyperbilirubinemia, and presence of HLA DRB1*03 characterize patients who fail corticosteroid treatment. The model for end-stage liver disease may be a useful instrument for identifying patients prone to this outcome. (HEPATOLOGY 2007;46:1138-1145

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Exacerbated autoimmune hepatitis successfully treated with leukocytapheresis and bilirubin adsorption therapy

Cited by 17 publications

References 17 publications

Leukocytapheresis (LCAP) in the Management of Chronic Active Ulcerative Colitis—Results of a Randomized Pilot Trial

Leukocytapheresis (LCAP) in the Management of Chronic Active Ulcerative Colitis—Results of a Randomized Pilot Trial

Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments

Features associated with treatment failure in type 1 autoimmune hepatitis and predictive value of the model of end-stage liver disease

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