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DOI: 10.1055/s-2008-1037665
Mycophenolate mofetil as second line therapy in Autoimmune Hepatitis?
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 36 patients (28 women, 8 men) with AIH proven according to International Autoimmune Hepatitis Group-criteria who failed standard therapy. 27 of 36 patients had experienced side effects necessitating stop of treatment. One patient stopped azathioprine due to pregnancy. 8 patients did not respond sufficiently to azathioprine. Results: 3 patients were excluded due to MMF intolerance or noncompliance. Of the remaining 33 patients 15 patients (45%) experienced remission being defined as AST< twice UNL. 18 patients (55%) did not respond sufficiently to MMF. The response rate to MMF was dependent on the cause of treatment cessation of azathioprine. Of 8 patients with prior nonresponse to azathioprine, 6 (75%) did not respond to MMF and only two (25%) reached a biochemical remission. Of 25 patients with azathioprine intolerance in 12 (48%) patients the response to MMF was insufficient and in 13 patients (52%) remission was reached. The difference did not reach statistical significance due to the relatively small numbers included. Conclusion: In the light of its good tolerability MMF seems to be an alternative for patients who could not tolerate azathioprine previously. However, our data suggest that a majority of patients fail MMF particularly if they are switched because of an insufficient response to azathioprine
Illustration of patient distribution
Mycophenolate mofetil - autoimmune hepatitis