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Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapy with prednisolone and azathioprine
Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine, Skåne University Hospital, Malmö, Sweden.
Department of Medicine, Sahlgren’s University Hospital, Göteborg, Sweden.
Department of Medicine, Akademiska Hospital, Uppsala, Sweden.
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2019 (English)In: Digestive and Liver Disease, ISSN 1590-8658, E-ISSN 1878-3562, Vol. 51, no 2, p. 253-257Article in journal (Refereed) Published
Abstract [en]

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levels were obtained (n = 3) or maintained (n = 7) in 10 patients (45%) after three to 30 weeks. 12 patients (55%) were withdrawn during the first 6 months, due to adverse events.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. (C) 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2019. Vol. 51, no 2, p. 253-257
Keywords [en]
Autoimmune hepatitis, Mycophenolate mofetil, Thiopurine failure
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-72428DOI: 10.1016/j.dld.2018.10.004ISI: 000457115900011PubMedID: 30389427Scopus ID: 2-s2.0-85055677387OAI: oai:DiVA.org:oru-72428DiVA, id: diva2:1288744
Note

Funding Agency:

Meda AB, Sweden

Available from: 2019-02-14 Created: 2019-02-14 Last updated: 2019-02-14Bibliographically approved

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Nyhlin, Nils

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