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Systematic review with meta‐analysis: mycophenolate mofetil as a second‐line therapy for autoimmune hepatitis
Author(s) -
Santiago Priscila,
Schwartz Ingrid,
Tamariz Leonardo,
Levy Cynthia
Publication year - 2019
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.15157
Subject(s) - medicine , discontinuation , azathioprine , adverse effect , meta analysis , autoimmune hepatitis , mycophenolate , gastroenterology , hepatitis , transplantation , disease
Summary Background First‐line treatment for autoimmune hepatitis (AIH) typically includes corticosteroids in combination with azathioprine. Mycophenolate mofetil (MMF) is often used as a rescue therapy in patients who are intolerant of, or nonresponsive to, standard therapy. Aim To systematically review studies and perform a meta‐analysis on the efficacy and safety of MMF as a second‐line therapy for AIH patients. Methods MEDLINE, EMBASE and Cochrane Central were searched for studies that reported data on efficacy and safety of MMF as a second‐line therapy in AIH. We calculated the pooled response rate, adverse events rate and discontinuation rate due to side effects, with their corresponding 95% confidence intervals. Results Twelve studies comprising 397 patients, followed for a median of 34 months (range, 12‐47 months), were included. MMF doses ranged from 0.5‐4.0 g/d. Pooled response rate was 0.58 (95% CI 0.54‐0.63). Pooled adverse events rate was 0.14 (95% CI 0.11‐0.17), and pooled discontinuation rate due to side effects was 0.08 (95% CI 0.06‐0.11). Five studies (n = 309) specified response rates according to reason for using MMF. Pooled response rate in the subgroup with intolerance to standard therapy was 0.82 (95% CI 0.77‐0.87) and pooled response rate among nonresponders was 0.32 (95% CI 0.24‐0.39). Conclusions The overall efficacy of MMF as second‐line therapy in AIH was high. Response rate was greater in patients who started the medication due to intolerance to standard therapy as opposed to nonresponse. Overall, MMF was well tolerated, with a low discontinuation rate due to side effects.