A systematic review and meta-analysis of second-line immunosuppressants for autoimmune hepatitis treatment

Lemos-Bonotto, Michele De; Valle-Tovo, Cristiane; Costabeber, Ane Micheli; Mattos, Angelo A.; Azeredo-da-Silva, André Luís Ferreira

doi:10.1097/meg.0000000000001019

Cited by 38 publications

(36 citation statements)

References 16 publications

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“…Mycophenolate seems to be an alternative option for patients intolerant to azathioprine . Calcineurin inhibitors (CNI) in combination with predniso(lo)ne also showed good results inducing clinical and biochemical remission . In contrast to other publications, the current study reports a better outcome with mycophenolate than with CNI‐containing regimens.…”

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confidence: 52%

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Editorial: “real world data” of AIH—time to connect!

Hupa-Breier

Taubert

Jaeckel

et al. 2018

Aliment Pharmacol Ther

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contrasting

confidence: 52%

“…So far there is no approved second‐line therapy for AIH available; randomised prospective trials are missing . Mycophenolate seems to be an alternative option for patients intolerant to azathioprine .…”

mentioning

confidence: 99%

Editorial: “real world data” of AIH—time to connect!

Hupa-Breier

Taubert

Jaeckel

et al. 2018

Aliment Pharmacol Ther

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“…However, most of the evidence for its use is derived from small retrospective studies, without specific guideline recommendations. A previous meta‐analysis included eight studies but did not assess rates of biochemical response . Therefore, we aimed to systematically review studies and perform a meta‐analysis on the efficacy and safety of MMF as a second‐line drug for AIH patients.…”

Section: Introductionmentioning

confidence: 99%

Systematic review with meta‐analysis: mycophenolate mofetil as a second‐line therapy for autoimmune hepatitis

Santiago

Schwartz

Tamariz

et al. 2019

Aliment Pharmacol Ther

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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.Additional supporting information will be found online in the Supporting Information section at the end of the article.How to cite this article: Santiago P, Schwartz I, Tamariz L, Levy C. Systematic review with meta-analysis: mycophenolate mofetil as a second-line therapy for autoimmune hepatitis.

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“…Reports from several groups have also supported the use of secondline agents, mycophenolate mofetil (in combination with prednisone) as initial therapy in adults and cyclosporine as initial therapy in children. 3,15 Among adults, cyclosporine and tacrolimus have been used typically in those who are intolerant or refractory to conventional therapy. 15,16 The second-line agents have rapid onset of efficacy but the current evidence is limited, gathered from small retrospective and heterogenous studies.…”

mentioning

confidence: 99%

“…3,15 Among adults, cyclosporine and tacrolimus have been used typically in those who are intolerant or refractory to conventional therapy. 15,16 The second-line agents have rapid onset of efficacy but the current evidence is limited, gathered from small retrospective and heterogenous studies. Prospective trials are needed to establish their role as initial therapy in AIH but nonetheless, the current report emphasizes the important point that AIH is typically a steroid-sensitive disease even at lower doses.…”

mentioning

confidence: 99%