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Transplant immunosuppressive agents in non‐transplant chronic autoimmune hepatitis: the Canadian association for the study of liver (CASL) experience with mycophenolate mofetil and tacrolimus
Author(s) -
Chatur Nazira,
Ramji Alnoor,
Bain Vincent G.,
Ma Mang M.,
Marotta Paul J.,
Ghent Cameron N.,
Lilly Leslie B.,
Heathcote E. Jenny,
Deschenes Marc,
Lee Samuel S.,
Steinbrecher Urs P.,
Yoshida Eric M.
Publication year - 2005
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2005.01107.x
Subject(s) - medicine , tacrolimus , autoimmune hepatitis , azathioprine , mycophenolic acid , prednisone , gastroenterology , population , immunosuppressive drug , hepatitis c , hepatitis , transplantation , disease , environmental health
Background: Conventional treatment of autoimmune hepatitis consists of either prednisone alone or in combination with azathioprine. Ten to 20% of patients do not respond to or are intolerant of this treatment. Novel drug treatments include immunosuppressive drugs such as tacrolimus (TAC), mycophenolate mofetil (MMF), methotrexate and cyclosporine. We describe a multi‐centre Canadian experience with MMF and TAC. Objective: To study a multi‐centre patient population who had failed conventional therapy and were treated with non‐conventional medical therapy for autoimmune hepatitis and document response. Methods: Members of the Canadian Association for the Study of Liver (CASL) obtained MMF from Hoffmann‐La Roche Ltd, as part of a compassionate release program, were contacted for standardized data on patients with AIH who received MMF or TAC. Response definitions based on aminotransferase changes were: Complete response (CR)‐sustained normalization, partial response (PR)‐improvement by greater than 50%, non‐response (NR)‐less than 50% improvement and relapse (RP)‐initial CR or PR followed by an increase in aminotransferases. Results: A total of 16 patients were identified: six in Ontario, one in Quebec, five in Alberta and four in British Columbia. Three were treated with TAC, eleven with MMF and two with combination MMF and TAC. CR was observed in 50%, PR in 12.5%, RP in 25% and NR occurred in 12.5%. The CR for MMF without TAC was approximately 64%. Conclusions: MMF is effective and well tolerated by patients with autoimmune hepatitis who do not respond to, or are intolerant of, conventional immunosuppressive agents.