The Use of Budesonide in the Treatment of Autoimmune Hepatitis in Canada

Zandieh, Iman; Krygier, Darin; Wong, Victor; Howard, John M.; Worobetz, Lawrence; Minuk, Gerald Y.; Witt-Sullivan, Helga; Yoshida, Eric M.

doi:10.1155/2008/509459

Cited by 42 publications

(30 citation statements)

References 43 publications

(51 reference statements)

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“…Among the different autoimmune diseases, the risk of developing RA is maximum [20]. Smoking affects the onset of RA at different level -(1) age: onset at young age in smokers [21], (2) sex: risk higher in men [20], (3) abundance: 2.4 times more risk in younger smokers [22], (4) duration of smoking: risk of developing RA in current, former and even 20 years after smoking cessation [23]. Cigarette smoking is mostly related with rheumatoid factor (RF) and anti-cyclic citrullinated protein (anti-CCP) antibody seropositivity [24].…”

Section: Different Autoimmune Diseases Triggered By Smokingmentioning

confidence: 99%

“…Due to the 15-fold higher affinity of budesonide to glucocorticoid receptors, it can be a second choice of prednisolone for induction and remission for the patients without the effect of cirrhosis [35]. This type of steroid has tested to give encouraging results with response rate of 80% in treatment-naive and non-responders to the standard ones [22,36]. Other interesting treatment strategy consists of different antibiotics like cyclosporine A.…”

Section: Treatments For Autoimmune Hepatitismentioning

confidence: 99%

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Bitter correlationship between autoimmune hepatitis and smoking

Bose

2015

Medical Hypotheses

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Section: Different Autoimmune Diseases Triggered By Smokingmentioning

confidence: 99%

Section: Treatments For Autoimmune Hepatitismentioning

confidence: 99%

Bitter correlationship between autoimmune hepatitis and smoking

Bose

2015

Medical Hypotheses

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“…Its metabolism and actions are similar to those of prednisone and prednisolone, but its focused hepatic delivery and low systemic availability have the theoretical advantage of combining precision targeting of the liver with low systemic toxicity. Multiple small single-center clinical experiences have demonstrated that budesonide can improve laboratory findings in treatment-naïve individuals [128][129][130][131], and they have justified the performance of a large randomized clinical trial comparing budesonide combined with azathioprine with a standard prednisone and azathioprine combination [132]. The budesonide combination normalized liver tests more frequently (47% versus 18%) and with fewer side effects (28% versus 53%) than the standard prednisone combination after 6 months [132].…”

Section: Budesonidementioning

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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“…The calcineurin inhibitors (cyclosporine and tacrolimus) [216,217] and the purine antagonist (mycophenolate mofetil) [218] have promise as site-specific drug therapies, and budesonide has been used in combination with azathioprine as an effective frontline regimen with low frequency of side effects [219,220]. These interventions should improve outcomes, and the boundaries of their success must be fully mapped before new studies can accurately address residual deficiencies.…”

Section: Logical Road Map For Future Studiesmentioning

confidence: 99%

Emerging Opportunities for Site-Specific Molecular and Cellular Interventions in Autoimmune Hepatitis

Czaja

2010

Dig Dis Sci

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Current corticosteroid-based treatments of autoimmune hepatitis frequently have incomplete or unsatisfactory outcomes, side effects, and excessive immune suppression. The goal of this review is to describe the advances in developing animal models of autoimmune hepatitis and in treating diverse immune-mediated diseases that make pursuit of site-specific molecular and cellular inventions in autoimmune hepatitis feasible. Prime source and review articles in English were selected by a Medline search through October 2009. A murine model infected with an adenovirus expressing human CYP2D6 is a resource for evaluating new therapies because of its histological and serological features, persistence, and progressive hepatic fibrosis. Synthetic analog peptides that block autoantigen expression, a dimeric recombinant human fusion protein of cytotoxic T lymphocyte antigen-4, monoclonal antibodies against tumor necrosis factor-alpha, recombinant interleukin 10, tolerization techniques for disease-triggering autoantigens, T regulatory cell transfer, vaccination against antigen-specific cytotoxic CD8+ T cells, and gene silencing methods using small inhibitory RNAs are feasible interventions to explore. Treatments directed at dampening immunocyte activation with soluble cytotoxic T lymphocyte antigen-4, inhibiting immunocyte differentiation with recombinant interleukin 10, and improving immunosuppressive activity with regulatory T cell modulation have the most immediate promise. Progress in the development of an animal model of autoimmune hepatitis and experiences in other immune-mediated diseases justify the evaluation of site-specific molecular and cellular interventions in this disease.

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The Use of Budesonide in the Treatment of Autoimmune Hepatitis in Canada

Cited by 42 publications

References 43 publications

Bitter correlationship between autoimmune hepatitis and smoking

Bitter correlationship between autoimmune hepatitis and smoking

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

Emerging Opportunities for Site-Specific Molecular and Cellular Interventions in Autoimmune Hepatitis

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