Refractory Autoimmune Hepatitis: Beyond Standard Therapy

There are limited therapeutic options available for patients with autoimmune hepatitis in whom conventional treatment fails. A case series of five patients unresponsive to or unable to take azathioprine, 6-mercaptopurine or corticosteroids who were treated with mycophenolate mofetil (MMF) is reported. While on MMF, alanine aminotransferase normalized or remained normal in all patients. MMF had a steroid-sparing effect and histological remission was demonstrated in one patient after seven months of MMF. One patient experienced an uncomplicated episode of pyelonephritis. In conclusion, MMF can effectively induce and maintain remission in refractory autoimmune hepatitis patients.

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Beneficial response to mycophenolate mofetil by patients with autoimmune hepatitis who have failed standard therapy, is predicted by older age and lower immunoglobulin G and INR levels

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.15248 ◽

2019 ◽

Vol 49 (10) ◽

pp. 1314-1322 ◽

Cited By ~ 7

Author(s):

Amanda J. Nicoll ◽

Stuart K. Roberts ◽

Ricky Lim ◽

Joanne Mitchell ◽

Martin Weltman ◽

...

Keyword(s):

Mycophenolate Mofetil ◽

Autoimmune Hepatitis ◽

Immunoglobulin G ◽

Standard Therapy ◽

Older Age ◽

Beneficial Response

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Mycophenolate mofetil for treatment of autoimmune hepatitis in patients resistant or intolerant to standard therapy

The American Journal of Gastroenterology ◽

10.1016/s0002-9270(01)03158-6 ◽

2001 ◽

Vol 96 (9) ◽

pp. S133-S134

Author(s):

A RASHDAN

Keyword(s):

Mycophenolate Mofetil ◽

Autoimmune Hepatitis ◽

Standard Therapy

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Mycophenolate mofetil as a rescue therapy for autoimmune hepatitis patients who are not responsive to standard therapy

Expert Review of Gastroenterology & Hepatology ◽

10.1586/egh.11.45 ◽

2011 ◽

Vol 5 (4) ◽

pp. 517-522 ◽

Cited By ~ 10

Author(s):

Hind I Fallatah ◽

Hisham O Akbar

Keyword(s):

Mycophenolate Mofetil ◽

Autoimmune Hepatitis ◽

Standard Therapy ◽

Rescue Therapy

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Autoimmune hepatitis and complexities in management

Frontline Gastroenterology ◽

10.1136/flgastro-2018-101015 ◽

2018 ◽

Vol 10 (1) ◽

pp. 77-87 ◽

Cited By ~ 2

Author(s):

Ashnila Janmohamed ◽

Gideon M Hirschfield

Keyword(s):

Liver Disease ◽

Autoimmune Hepatitis ◽

Standard Therapy ◽

Effective Therapy ◽

Adult Patients ◽

Therapeutic Options ◽

Second Line ◽

Immune Mediated ◽

Vast Variation ◽

Case Based

Autoimmune hepatitis (AIH) is a rare heterogenous immune-mediated liver disease that for the majority has effective therapy, usually resulting in excellent prognosis. Treatment is based on immunosuppression using standard therapy with corticosteroids and azathioprine. Second-line therapeutic options exist for those who are non-responders (‘difficult to treat AIH’) or intolerant to standard therapy; however, their use is not standardised, and in addition, there is vast variation in practice and efficacy. Given the rarity of AIH, expertise in its management can be limited to large referral programmes. In this case-based review, we aim to discuss common clinical dilemmas encountered by clinicians managing adult patients with AIH and address the related competencies in the 2010 Gastroenterology curriculum.

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