A recent retrospective study (C Efe et al. Clin Gastroenterol Hepatol 2017; 15: 1950-6) examined both mycophenolate mofetil (MMF, n=121) and tacrolimus (TAC, n=80) as second-line therapies for autoimmnue hepatitis with a median followup of 62 months. Patients were divided into two groups. The first group (n=108) had a complete response to steroids/azathioprine but had side effects. The second group (n=93) were nonresponders to steroids/azathioprine. Overall, the cohort examined patients as young as 7 years and as old as 76 years.
- No significant difference in complete response noted in 69.4% of MMF-treated compared with 72.4% in TAC-treated patients.
- In group 1 patients (responders to azathioprine), MMF and TAC maintained biochemical remission in 91.9% and 94.1% respectively.
- In group 2 (prior nonresponders), TAC-treated patients had a complete response rate of 56.5% compared with 34% for MMF-treated patients (P=.029).
- Liver-related deaths and transplantation occurred with similar rates: MMF 13.2% compared with TAC 10.3%. With each treatment, 10 patients withdrew from treatment due to side effects.
My take: In this study, both agents were effective in those who changed due to side effects. However, tacrolimus-treated patients had a higher response among prior nonresponders.
Related blog posts:
- Slim Pickings: Data for 2nd Line Treatment in Pediatric Autoimmune Hepatitis
- Autoimmune Liver Disease in Children with Sickle Cell Anemia
- Azathioprine metabolite measurement in Autoimmune Hepatitis
- Adult versus Pediatric Data: Autoimmune Hepatitis
- Diagnosing autoimmune hepatitis
- Withdrawing immunosuppression with autoimmune hepatitis
- Liver Problems with Inflammatory Bowel Disease
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