Anti TNF‐α therapy can be a novel treatment option in patients with autoimmune hepatitis

作者：Cumali Efe, Tuğrul Pürnak, Ersan Özaslan · 发表于：Alimentary Pharmacology & Therapeutics · 年份：2010 · DOI：10.1111/j.1365-2036.2010.04316.x · 被引用次数：10 · 研究领域：Liver Diseases and Immunity、Liver Disease Diagnosis and Treatment、Pediatric Hepatobiliary Diseases and Treatments

Sirs, Autoimmune hepatitis (AIH) is a progressive, chronic disorder that affects persons of all age groups. An environmental agent that triggers a cascade of T-cell–mediated immune response may have a role in the pathogenesis of AIH. Activation of T-cells leads to increased circulating levels of the pro-inflammatory cytokines, such as IL-6, IL-8 and tumour necrosis factor-alpha (TNF-α).1, 2 We read with great interest the article by Yeoman et al. regarding the modern management of AIH.3 They explained that standard or first line therapy (corticosteroids and azathioprine) for AIH is effective in more than 80% of cases. However, it is obvious that an alternative approach is needed for the remaining 20% of patients. Mycophenolate mofetil, tacrolimus and cyclosporin are second line agents, but there are no clear data about their net effect in these patients. Tumour necrosis factor-alpha blocking agents are commonly used drugs in the auto-immune diseases of rheumatology, dermatology and gastroenterology, but hepatic failure or the development of AIH has been reported as a rare side effect of these drugs.4 Recently, Weiler-Normann et al.5 reported a patient with drug-resistant AIH who was treated successfully with a TNF-α blocking agent (infliximab). From a pathophysiological point of view, we think that TNF-α blocking therapy might be a candidate as a new treatment option for patients with standard therapy resistant AIH. Declaration of personal and funding interests: None.