Transplant immunosuppressive agents in non‐transplant chronic autoimmune hepatitis: the Canadian association for the study of liver (CASL) experience with mycophenolate mofetil and tacrolimus

Chatur, Nazira; Ramji, Alnoor; Bain, Vincent G.; Mang, M.; Marotta, Paul; Ghent, Cameron N.; Lilly, Leslie; Heathcote, E. Jenny; Deschênes, Marc; Lee, Samuel S.; Steinbrecher, Urs P.; Yoshida, Eric M.

doi:10.1111/j.1478-3231.2005.01107.x

Cited by 108 publications

(93 citation statements)

References 9 publications

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“…We recently completed a randomized controlled head-to-head comparison of low-dose cyclosporine with prednisolone for AIH induction therapy and found that low-dose cyclosporine is as effective as prednisolone, but less toxic (20). In addition to cyclosporine, other calcineurin inhibitors like tacrolimus (21,22) and purine antagonists like mycophenolate mofetil (21) have been used successfully to treat corticosteroid-resistant AIH patients. In a randomized controlled trial, budesonide has recently been shown to be as effective as prednisolone, with fewer side effects (23).…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Long Term Outcome of 102 Treated Autoimmune Hepatitis Patients

et al. 2012

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Article type: Original ArticleBackground: There is limited data on the natural history of autoimmune hepatitis (AIH) and on the long-term follow-up of AIH patients who have been referred for regular medical attention. Objectives: We evaluated the clinical presentation and natural history of AIH in a large cohort of type I AIH patients from Iran. Patients and Methods: Between 1997 and 2008, 102 patients were enrolled in the study. Patients were diagnosed using the International Autoimmune Hepatitis Group criteria and were followed up for an average of 60 months. Clinical and biochemical data were gathered from all the patients at both the beginning and the end of the follow-up period. Liver biopsy was performed in all patients before treatment, and the biopsies were performed in 28 patients after treatment. Results: Biochemical remission was achieved by 80 (79.4%) patients. Of these, 53 (66.5%) showed near-normal liver histology or liver function test results and sonogram. The remaining 27 (33.5%) patients also achieved clinical and biochemical remission, but developed compensated cirrhosis. After a period of remission, 24 patients (32.5%) relapsed. Among the 22 (21.6%) patients who showed ultimate treatment failure, 6 underwent orthotopic liver transplantation and 3 died of liver failure while awaiting a transplant. Sixteen (72.7%) of the 22 patients who did not respond to therapy were non-compliant with medications and had irregular follow-up. The overall 10-year survival rate in the cohort was 96%. Conclusions: Long-term survival in AIH patients is very good. Prompt diagnosis and appropriate first-line and salvage therapy that includes close follow-up will make liver transplantation a rare necessity in the treatment of this disease.

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Section: Discussionmentioning

confidence: 99%

Clinical Features and Long Term Outcome of 102 Treated Autoimmune Hepatitis Patients

et al. 2012

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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.…”

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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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“…Eight (50%) had complete response, 2 (12.5%) had partial response, 4 (25%) had no response and 2 (12.5%) relapsed after 26.5 months follow-up. 23 Zachou and colleagues performed a prospective study in 59 patients assessing the efficacy of MMF as first line therapy in patients with AIH. Eighty eight percent (88%) of them responded to the combination of tapering dose of prednisolone and MMF 1-2 g/day within 3 months and the remaining patients responded eventually.…”

Section: Discussionmentioning

confidence: 99%

Role of Mycophenolate Mofetil for the Treatment of Autoimmune Hepatitis—An Observational Study

Jothimani

Cramp

Cross

2014

Journal of Clinical and Experimental Hepatology

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Transplant immunosuppressive agents in non‐transplant chronic autoimmune hepatitis: the Canadian association for the study of liver (CASL) experience with mycophenolate mofetil and tacrolimus

Abstract: MMF is effective and well tolerated by patients with autoimmune hepatitis who do not respond to, or are intolerant of, conventional immunosuppressive agents.

Cited by 108 publications

References 9 publications

Clinical Features and Long Term Outcome of 102 Treated Autoimmune Hepatitis Patients

Clinical Features and Long Term Outcome of 102 Treated Autoimmune Hepatitis Patients

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

Role of Mycophenolate Mofetil for the Treatment of Autoimmune Hepatitis—An Observational Study

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