scholarly journals Mycophenolate Mofetil for the Treatment of Autoimmune Hepatitis in Patients Refractory to Standard Therapy

2004 ◽  
Vol 18 (5) ◽  
pp. 321-326 ◽  
Author(s):  
Shane M Devlin ◽  
Mark G Swain ◽  
Stefan J Urbanski ◽  
Kelly W Burak
Keyword(s):  
Mycophenolate Mofetil ◽  
Autoimmune Hepatitis ◽  
Alanine Aminotransferase ◽  
Standard Therapy ◽  
Conventional Treatment ◽  
Case Series ◽  
Therapeutic Options ◽  
Sparing Effect ◽  
Histological Remission ◽  
Steroid Sparing

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.

Steroid-Sparing Effect Of Mycophenolate Mofetil In Pulmonary Sarcoidosis

2010 ◽  
Author(s):  
Preetam Jolepalem ◽  
Nevins W. Todd ◽  
Edward J. Britt ◽  
Michael Terrin ◽  
Carla Peterman ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Pulmonary Sarcoidosis ◽  
Sparing Effect ◽  
Steroid Sparing

scholarly journals Methotrexate Use in Generalized Autoimmune Myasthenia Gravis: A Case series

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Preston Eibling ◽  
Yuebing Li ◽  
Robert Marquardt
Keyword(s):  
Side Effects ◽  
Myasthenia Gravis ◽  
Retrospective Analysis ◽  
Acetylcholine Receptor ◽  
Average Duration ◽  
Case Series ◽  
Immunosuppressive Medication ◽  
Autoimmune Myasthenia ◽  
Sparing Effect ◽  
Steroid Sparing

Methotrexate (MTX) is an inexpensive and well-tolerated immunosuppressive medication that is used anecdotally in autoimmune myasthenia gravis (MG). However, the efficacy in MG is unclear at this time. This retrospective analysis describes six patients with acetylcholine receptor antibody positive MG who were treated with MTX and corticosteroids. The efficacy of MTX was measured by steroid-sparing effect and the Myasthenia Gravis Foundation of America (MGFA) classification. MTX initiation was associated with a reduction in prednisone dosage in all patients. Minimal manifestation status was reached at an average duration of 10 months in 5 patients.  No patients were hospitalized for myasthenia gravis exacerbations. There were no major side effects experienced with MTX use.  This retrospective analysis suggests that MTX is safe and probably efficacious as a corticosteroid-sparing agent in the management of MG.

scholarly journals Use Of Leflunomide In Patients With Hypersensitivity Pneumonitis

2020 ◽  
Author(s):  
Sungryong Noh ◽  
Ruchi Yadav ◽  
Manshi Li ◽  
Xiaofeng Wang ◽  
Debasis Sahoo ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Lung Function ◽  
Adverse Effects ◽  
Pulmonary Function ◽  
Hypersensitivity Pneumonitis ◽  
Second Line ◽  
Significant Fibrosis ◽  
Discontinue Therapy ◽  
Sparing Effect ◽  
Steroid Sparing

Abstract Prednisone has been shown to reverse lung function declines in hypersensitivity pneumonitis patients without established fibrosis. Second line immunosuppressants like azathioprine and mycophenolate mofetil have a steroid sparing effect and improve DLCO. There is no published literature on the use of leflunomide in such patients. We reviewed our experience with leflunomide for treatment of hypersensitivity pneumonitis in 40 patients. We stratified patients according to the presence or absence of significant (>20%) fibrosis. We studied the effect of leflunomide on FVC and DLCO trajectory and reported the changes at 12 months.Treatment with leflunomide tended to improve the estimated FVC slope from 0.18±1.90% (SEM) of predicted per year to 4.62±1.65% of predicted (NS, p=0.118). It significantly improved the FVC at 12 months of treatment by 4.4% of predicted (p=0.02). DLCO continued to increase at 1.45±1.44% (SEM) of predicted per year. Non-fibrotic HP patients had the largest gain in pulmonary function. Their FVC increased by 8.3% (p=0.001) and DLCO by 4.8% (p=0.011). Patients with fibrotic HP did not improve. Leflunomide treatment was associated with significant gastrointestinal and other adverse effects leading 40% of patients to discontinue therapy. It had a significant steroid sparing effect with half the patients weaned off prednisone entirely.Leflunomide appears to be a fairly well tolerated steroid sparing immunosuppressant that improves pulmonary function in HP patients. It is most effective in patients without significant fibrosis.

Mycophenolate mofetil and myasthenia gravis

Lupus ◽  
2005 ◽  
Vol 14 (3_suppl) ◽  
pp. 46-49 ◽  
Author(s):  
E Ciafaloni
Keyword(s):  
Mycophenolate Mofetil ◽  
Side Effects ◽  
Myasthenia Gravis ◽  
Neuromuscular Transmission ◽  
Autoimmune Disorder ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Multicenter Trials ◽  
Sparing Effect ◽  
Steroid Sparing

Myasthenia gravis (MG) represents the prototypic autoimmune disorder with well characterized immunopathology. Advances in the diagnosis and treatment of this neuromuscular transmission disorder have significantly improved the management of myasthenic patients. Unfortunately the currently available immunomodulating treatments have significant side effects and some patients do not tolerate them or adequately respond to them. Therefore the possibility of a new immunosuppressant agent that is safe, effective and has steroid-sparing effect is very appealing. Mycophenolate mofetil (MMF) has shown promising effects in MG patients in preliminary studies and is currently being studied in two prospective, randomized, double-blind, placebo controlled, multicenter trials to better establish its role in the treatment of MG.

scholarly journals Autoimmune hepatitis and complexities in management

2018 ◽  
Vol 10 (1) ◽  
pp. 77-87 ◽  
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.

Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapy with prednisolone and azathioprine

2019 ◽  
Vol 51 (2) ◽  
pp. 253-257 ◽  
Author(s):  
Georgios Giannakopoulos ◽  
Hans Verbaan ◽  
Inga-Lill Friis-Liby ◽  
Per Sangfelt ◽  
Nils Nyhlin ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Autoimmune Hepatitis ◽  
Standard Therapy

Efficacy and Safety of Mycophenolate Mofetil in Patients With Autoimmune Hepatitis and Suboptimal Outcomes After Standard Therapy

2018 ◽  
Vol 16 (2) ◽  
pp. 268-277 ◽  
Author(s):  
Stuart K. Roberts ◽  
Ricky Lim ◽  
Simone Strasser ◽  
Amanda Nicoll ◽  
Alessia Gazzola ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Autoimmune Hepatitis ◽  
Standard Therapy ◽  
Efficacy And Safety
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