Mycophenolate Mofetil as Second Line Therapy in Autoimmune Hepatitis?

作者：Elke M. Hennes, Ye Htun Oo, Christoph Schramm, Ulrike Walburga Denzer, Peter Buggisch, Christiane Wiegard, Stephan Kanzler, Marcus Schuchmann, Wulf O. Boecher, Peter R. Galle, David Adams, Ansgar Wilhelm Lohse · 发表于：The American Journal of Gastroenterology · 年份：2008 · DOI：10.1111/j.1572-0241.2008.02180.x · 被引用次数：189 · 研究领域：Liver Diseases and Immunity、Systemic Lupus Erythematosus Research、Pregnancy and Medication Impact

INTRODUCTION: In patients with autoimmune hepatitis, efficient immunosuppressive therapy is essential to avoid progression to cirrhosis. There is no established second line therapy for patients failing standard therapy with steroids and azathioprine. The aim of this study was to examine the possible role of mycophenolate mofetil (MMF) as second line treatment of autoimmune hepatitis (AIH). PATIENTS AND METHODS: We were able to identify 37 patients (29 women, 8 men) with AIH proven according to International AIH Group criteria who failed standard therapy. One patient on MMF was excluded due to non-compliance. A total of 28 of 36 patients had experienced side effects necessitating stop of treatment. One patient stopped azathioprine due to pregnancy. A total of nine patients did not respond sufficiently to azathioprine. A total of four patients with a treatment duration of 3 months or less because of severe side effects were considered as intolerant to MMF. Remission was defined as aspartate transaminase (ASP) < twice upper normal limit (UNL). RESULTS: Of 36 patients on MMF included in the analysis, 14 patients (39%) experienced remission. A total of 22 patients (61%) did not respond sufficiently to MMF. The response rate to MMF was dependent on the cause of treatment cessation of azathioprine. Of eight patients with prior nonresponse to azathioprine, six (75%) did not respond to MMF and only two (25%) reached biochemical remission. Of 28 patients with azathioprine intolerance i...