Mycophenolate mofetil as an alternative treatment for autoimmune hepatitis

Abstract

Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease characterized by hepatocellular inflammation, necrosis, and fibrosis, which can progress to cirrhosis and fulminant hepatic failure. The standard treatment for AIH includes corticosteroids alone or in combination with azathioprine. Although most patients achieve remission using the standard regimen, some patients do not respond due to either drug intolerance or refractory disease; in such cases alternative immunosuppressive agents should be explored. The second-line therapies are cyclophilin inhibitors such as cyclosporine A or tacrolimus, and nowadays mycophenolate mofetil (MMF) is widely used if azathioprine-based therapies are not tolerated. Although these are recommended as an alternative to the first-line regimen, there is insufficient evidence for the efficacy of second-line therapies, with the evidence based mainly on expert opinion. Therefore, we report an AIH patient receiving the standard regimen in whom remission did not occur due to side effects to azathioprine, but was successfully treated with MMF in combination with corticosteroids as an alternative to the standard regimen.

Human Cytomegalovirus Upregulates Expression of HCLS1 Resulting in Increased Cell Motility and Transendothelial Migration during Latency

“…Finally, we also show that mycophenolate mofetil (MMF), which modulates actin polymerization (Chaigne-Delalande et al., 2008, Dubus et al., 2003) and prevents monocyte adhesion and transmigration (Glomsda et al., 2003, Park et al., 2016), also prevented latently infected CD14+ monocytes from adhering to the endothelial layer during physiological flow conditions. This is consistent with the view that it is the increased stability of filamentous actin in latently infected monocytes, mediated by HCLS1 upregulation, which enhances their motility and crossing of endothelial cell layers.…”

Diagnosis and Treatment of Autoimmune Liver Diseases in a Tertiary Referral Center in Cuba

“…MMF is widely used in the treatment of AIH as an alternative to the standard regimen, often with good results, in patients with intolerance, treatment failure, or refractory disease. 38 Our 2 patients who failed to respond to standard treatment had a good response to MMF.…”

Mycophenolate mofetil as a treatment for presumed idiopathic chronic hepatitis in dogs: Six cases (2010–2022)

“…In humans with autoimmune hepatitis, MMF in combination with corticosteroids is an emerging first line treatment and has moderate efficacy as a second line treatment (Doycheva et al., 2019). Standard treatment with prednisone with or without AZA has been static for decades based on high efficacy and good outcomes, but as some patients develop intolerable adverse effects or have a suboptimal response to AZA, MMF has been demonstrated to be a viable alternative treatment (Doycheva et al., 2019; Park et al., 2016). In a prospective study of 59 patients treated with MMF and prednisolone, 88% achieved biochemical remission as defined by normalization of aminotransferases, with 69% achieving this endpoint within the first 3 months of therapy (Zachou et al., 2011).…”

“…MMF is a prodrug of mycophenolic acid that works by inhibiting proliferation of T and B lymphocytes and leads to the suppression of cell‐mediated immune responses and antibody formation (Langman et al., 1996). In human medicine, MMF has been shown to lead to improvement of hepatitis in 39%–84% of patients and is considered to be an alternative treatment option for patients who are refractory to prednisone treatment alone or have significant side effects of AZA (Park et al., 2016). There are currently no studies in veterinary medicine on the use of MMF in the treatment of ICH in dogs.…”