Clin Mol Hepatol.  2016 Jun;22(2):281-285. 10.3350/cmh.2015.0040.

Mycophenolate mofetil as an alternative treatment for autoimmune hepatitis

Affiliations
  • 1Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. umsh@korea.ac.kr

Abstract

Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease characterized by hepatocellular inflammation, necrosis, and fibrosis, which can progress to cirrhosis and fulminant hepatic failure. The standard treatment for AIH includes corticosteroids alone or in combination with azathioprine. Although most patients achieve remission using the standard regimen, some patients do not respond due to either drug intolerance or refractory disease; in such cases alternative immunosuppressive agents should be explored. The second-line therapies are cyclophilin inhibitors such as cyclosporine A or tacrolimus, and nowadays mycophenolate mofetil (MMF) is widely used if azathioprine-based therapies are not tolerated. Although these are recommended as an alternative to the first-line regimen, there is insufficient evidence for the efficacy of second-line therapies, with the evidence based mainly on expert opinion. Therefore, we report an AIH patient receiving the standard regimen in whom remission did not occur due to side effects to azathioprine, but was successfully treated with MMF in combination with corticosteroids as an alternative to the standard regimen.

Keyword

Mycophenolate mofetil; Autoimmune hepatitis; Azathioprine

MeSH Terms

Alanine Transaminase/analysis
Alopecia/etiology
Antibiotics, Antineoplastic/*therapeutic use
Aspartate Aminotransferases/analysis
Azathioprine/adverse effects
Female
Hepatitis, Autoimmune/*drug therapy/pathology
Humans
Liver/enzymology/pathology
Middle Aged
Mycophenolic Acid/*therapeutic use
Pancytopenia/etiology
Prednisolone/therapeutic use
Alanine Transaminase
Antibiotics, Antineoplastic
Aspartate Aminotransferases
Azathioprine
Mycophenolic Acid
Prednisolone
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