Long-term outcome of patients with difficult-to-treat autoimmune hepatitis receiving mycophenolate mofetil

• Type: Article in International Scientific Journal
• Date: 2021

Authors

Liberal, R (Author) Other; Gaspar, R (Author) Other; Lopes, S (Author) FMUP; Macedo G (Author) FMUP

Journal

Title: Clinics and Research in Hepatology and Gastroenterology

Vol. 45

ISSN: 2210-7401

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 3 Citations

Scopus - 4 Citations

Other information

Authenticus ID: P-00T-QXA

DOI: 10.1016/j.clinre.2020.06.013

Abstract (EN): Background: Most patients with autoimmune hepatitis (AIH) respond to a combination of prednisolone and azathioprine. For patients who are intolerant or refractory to azathioprine, proposed alternative therapies are based on scarce data, limited to transplant centres and with short-term follow-up periods. Objective: To evaluate the long-term efficacy and safety of MMF as a second-line therapy in patients with AIH managed at a tertiary non-transplant centre. Methods: Retrospective analysis of a prospectively collated database identified AIH patients who received MMF from 2006 to 2015. Clinical, biochemical and immunological parameters were assessed at 3-, 6- and 12-months, and at last follow-up. Biochemical response (BR) was defined as improvement of transaminases, complete remission (CR) as normalisation of transaminases and IgG, while others were considered non-responders (NR). Results: Eighteen out of 151 (12%) AIH patients received MMF. Nine received MMF due to azathioprine-intolerance (group 1), while nine due to refractory disease (group 2). In group 1, CR and BR was achieved in six (67%) and two (22%) patients respectively. In group 2, CR and BR was achieved in one (11%) and five (56%) patients respectively. Adverse events occurred in eight patients (44%), with one patient requiring drug discontinuation. After a medium follow-up of 78 (31-116) months, there was a significant decrease in transaminase levels, mirrored by decrease in prednisolone dose from 25 to 6.25 mg/day (P < 0.05). Conclusion: Long-term therapy with MMF is safe and effective in AIH patients requiring secondline therapies, and these patients can be effectively managed at tertiary non-liver transplantcentres.

Language: English

Type (Professor's evaluation): Dissemination

No. of pages: 9