Long-term outcome of patients with difficult-to-treat autoimmune hepatitis receiving mycophenolate mofetil - 20/04/21
, Rui Gaspar a, b, Susana Lopes a, b, Guilherme Macedo a, bBienvenue sur EM-consulte, la référence des professionnels de santé.
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| pages | 9 |
| Iconographies | 4 |
| Vidéos | 0 |
| Autres | 0 |
Highlights |
• | Long-term therapy with MMF is safe and effective in AIH patients requiring second-line therapies. |
• | These patients can be effectively managed at tertiary non-liver transplant centres. |
Summary |
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 second-line therapies, and these patients can be effectively managed at tertiary non-liver transplant centres.
Le texte complet de cet article est disponible en PDF.Keywords : Autoimmune hepatitis, Second-line therapy, Mycophenolate mofetil
Plan
Vol 45 - N° 2
Article 101487- mars 2021 Retour au numéro
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