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Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapy with prednisolone and azathioprine

Giannakopoulos, Georgios ; Verbaan, Hans LU ; Friis-Liby, Inga Lill ; Sangfelt, Per ; Nyhlin, Nils and Almer, Sven (2018) In Digestive and Liver Disease
Abstract

Background: Data on rescue treatment of autoimmune hepatitis in patients that fail standard treatment are sparse. Aims: To report our long-term experience with mycophenolate mofetil. Methods: Retrospective study in 22 patients with autoimmune hepatitis who failed azathioprine and prednisolone due to adverse events (n = 14, 64%), lack of remission (n = 5, 23%) or a combination (n = 3, 13%). Results: Mycophenolate mofetil was started at a dose of 20 mg/kg/day and increased to a maximum of 3 g/day. Follow-up was 0–6 months in 7 patients; more than 12 months in 15 (68%) and more than 24 months in 10. Normal aminotransferase levels were obtained (n = 3) or maintained (n = 7) in 10 patients (45%) after three to 30 weeks. 12 patients (55%)... (More)

Background: Data on rescue treatment of autoimmune hepatitis in patients that fail standard treatment are sparse. Aims: To report our long-term experience with mycophenolate mofetil. Methods: Retrospective study in 22 patients with autoimmune hepatitis who failed azathioprine and prednisolone due to adverse events (n = 14, 64%), lack of remission (n = 5, 23%) or a combination (n = 3, 13%). Results: Mycophenolate mofetil was started at a dose of 20 mg/kg/day and increased to a maximum of 3 g/day. Follow-up was 0–6 months in 7 patients; more than 12 months in 15 (68%) and more than 24 months in 10. Normal aminotransferase levels were obtained (n = 3) or maintained (n = 7) in 10 patients (45%) after three to 30 weeks. 12 patients (55%) were withdrawn during the first 6 months, due to adverse events. Three patients were switched to cyclosporine and one underwent liver transplantation. Successful treatment with mycophenolate mofetil continued in 10 patients (45%) for a median of 71 months (range 20–124). Of these, one stopped prednisolone, five have a prednisolone dose <5 mg daily and four patients 5–10 mg. Conclusion: Approximately one of two patients with autoimmune hepatitis that fail standard treatment benefit from long-term maintenance with mycophenolate mofetil, especially those with previous intolerance to thiopurines, where mycophenolate mofetil is effective in two thirds.

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Contribution to journal
publication status
epub
subject
keywords
Autoimmune hepatitis, Mycophenolate mofetil, Thiopurine failure
in
Digestive and Liver Disease
publisher
Elsevier
external identifiers
  • scopus:85055677387
  • pmid:30389427
ISSN
1590-8658
DOI
10.1016/j.dld.2018.10.004
language
English
LU publication?
no
id
ff6a3b6a-de5e-4e16-9247-fe4ce4d9f9d8
date added to LUP
2018-12-07 12:29:28
date last changed
2020-11-24 01:41:40
@article{ff6a3b6a-de5e-4e16-9247-fe4ce4d9f9d8,
  abstract     = {<p>Background: Data on rescue treatment of autoimmune hepatitis in patients that fail standard treatment are sparse. Aims: To report our long-term experience with mycophenolate mofetil. Methods: Retrospective study in 22 patients with autoimmune hepatitis who failed azathioprine and prednisolone due to adverse events (n = 14, 64%), lack of remission (n = 5, 23%) or a combination (n = 3, 13%). Results: Mycophenolate mofetil was started at a dose of 20 mg/kg/day and increased to a maximum of 3 g/day. Follow-up was 0–6 months in 7 patients; more than 12 months in 15 (68%) and more than 24 months in 10. Normal aminotransferase levels were obtained (n = 3) or maintained (n = 7) in 10 patients (45%) after three to 30 weeks. 12 patients (55%) were withdrawn during the first 6 months, due to adverse events. Three patients were switched to cyclosporine and one underwent liver transplantation. Successful treatment with mycophenolate mofetil continued in 10 patients (45%) for a median of 71 months (range 20–124). Of these, one stopped prednisolone, five have a prednisolone dose &lt;5 mg daily and four patients 5–10 mg. Conclusion: Approximately one of two patients with autoimmune hepatitis that fail standard treatment benefit from long-term maintenance with mycophenolate mofetil, especially those with previous intolerance to thiopurines, where mycophenolate mofetil is effective in two thirds.</p>},
  author       = {Giannakopoulos, Georgios and Verbaan, Hans and Friis-Liby, Inga Lill and Sangfelt, Per and Nyhlin, Nils and Almer, Sven},
  issn         = {1590-8658},
  language     = {eng},
  publisher    = {Elsevier},
  series       = {Digestive and Liver Disease},
  title        = {Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapy with prednisolone and azathioprine},
  url          = {http://dx.doi.org/10.1016/j.dld.2018.10.004},
  doi          = {10.1016/j.dld.2018.10.004},
  year         = {2018},
}