Infliximab as a rescue treatment in difficult-to-treat autoimmune hepatitis

Weiler‐Normann, Christina; Schramm, Christoph; Quaas, Alexander; Wiegard, Christiane; Glaubke, C; Pannicke, Nadine; Möller, Sina; Lohse, Ansgar W.

doi:10.1016/j.jhep.2012.11.010

Cited by 204 publications

(163 citation statements)

References 31 publications

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“…Biochemical and histological remission were achieved, respectively, in 8 patients and in all of the five subjects submitted to follow-up liver biopsy. These results were promising in this difficult-to-treat patients, but it caution is advised with the use of these agents, due to their enhanced risk to induce viral and bacterial infections, particularly in subjects with cirrhosis (56) . Ursodeoxicholic acid (UDCA) is a choleretic and immunomodulatory drug that was also evaluated in the treatment of AIH.…”

Section: Management and Treatment Of Aihmentioning

confidence: 97%

“…Anti-TNF alpha agents, such as infliximabe, etanercept and adalimumabe are commonly used for treatment of rheumatoid arthritis, psoriasis and IBD. Weiler-Normann et al (56) have recently reported the use of infliximabe in 11 patients with refractory AIH. They have employed the drug, given as an intravenous infusion of 5mg/kg/dose, at days one, 14 and 42 of therapy and repeated thereafter every four to six weeks, depending on the treatment response.…”

Section: Management and Treatment Of Aihmentioning

confidence: 99%

See 1 more Smart Citation

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

Bittencourt

Cançado

Couto

et al. 2015

Arq. Gastroenterol.

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-In order to draw evidence-based recommendations concerning the management of autoimmune diseases of the liver, the Brazilian Society of Hepatology has sponsored a single-topic meeting in October 18th, 2014 at São Paulo. An organizing committee comprised of seven investigators was previously elected by the Governing Board to organize the scientific agenda as well as to select twenty panelists to make a systematic review of the literature and to present topics related to the diagnosis and treatment of autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cirrhosis and their overlap syndromes. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.

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Section: Management and Treatment Of Aihmentioning

confidence: 97%

Section: Management and Treatment Of Aihmentioning

confidence: 99%

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

Bittencourt

Cançado

Couto

et al. 2015

Arq. Gastroenterol.

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“…As autoimmune hepatitis is characterised by hepatic inflammation and the proliferation of liver-infiltrating cytotoxic lymphocytes that differentiate and proliferate along a type 1 cytokine pathway, 227 agents that neutralise pro-inflammatory cytokines, such as tumour necrosis factor-alpha (TNF-a), have a strong rationale as anti-fibrotic therapies. 228 Such agents, however, including etanercept, 229,230 infliximab, 47,230 and pentoxifylline, 231 have either not improved mortality, had serious side effects, or exhibited no anti-fibrotic activity in diverse non-autoimmune liver diseases. Infliximab did rescue 7 of 11 patients with steroid-refractory autoimmune hepatitis, 47 but concerns about infectious complications 47,228 and drug-induced autoreactivity 230,[232][233][234] have justified a cautious interest in this agent.…”

Section: Feasible Anti-fibrotic Interventions In Autoimmune Hepatitismentioning

confidence: 99%

“…[28][29][30][31][32][33][34][35][36][37][38][39] The prevention or reversal of hepatic fibrosis has continued to be a secondary and uncertain outcome of these advances. 6,[40][41][42][43] Molecular and cellular interventions are now feasible with monoclonal antibodies against critical cytokine pathways (monoclonal antibodies to CD3, 44,45 CD20, 46 and tumour necrosis factor-a 47 ). Recombinant molecules, such as cytotoxic T lymphocyte antigen-4 fused with immunoglobulin, 48 may dampen lymphocyte activation, and cellular interventions, such as the adoptive transfer of regulatory T cells 49,50 and the sensitisation of natural killer T cells by disease-specific glycolipids, 51 may stimulate or inhibit counter-regulatory immune mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

Czaja

2014

Aliment Pharmacol Ther

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SummaryBackgroundImmunosuppressive treatment of autoimmune hepatitis can prevent or reverse hepatic fibrosis, but these anti‐fibrotic effects are inconsistent secondary gains.AimTo describe the anti‐fibrotic effects of current therapies for autoimmune hepatitis, discuss the pathogenic mechanisms of hepatic fibrosis that might be targeted by anti‐fibrotic interventions, indicate the non‐invasive diagnostic tests of hepatic fibrosis that must be validated in autoimmune hepatitis and to suggest promising treatment opportunities.MethodsStudies cited in PubMed from 1972 to 2013 for autoimmune hepatitis, hepatic fibrosis, cirrhosis, anti‐fibrotic therapy and non‐invasive tests of hepatic fibrosis were selected.ResultsHepatic fibrosis improves in 53–57% of corticosteroid‐treated patients with autoimmune hepatitis; progressive fibrosis slows or is prevented in 79%; and cirrhosis may be reversed. Progressive hepatic fibrosis is associated with liver inflammation, and the inability to fully suppress inflammatory activity within 12 months is associated with progression to cirrhosis (54%) and death or need for liver transplantation (15%). Liver tissue examination remains the gold standard for assessing hepatic fibrosis, but laboratory and radiological tests may be useful non‐invasive methods to measure the fibrotic response. Severe liver inflammation can confound radiological assessments, and the preferred non‐invasive test in autoimmune hepatitis is uncertain. Individualised treatment adjustments and adjunctive anti‐fibrotic therapies are poised for study in this disease.ConclusionsThe prevention and reversal of hepatic fibrosis are achievable objectives in autoimmune hepatitis. Strategies that evaluate individualised therapies adjusted to the rapidity and completeness of the inflammatory response, and the use of adjunctive anti‐fibrotic interventions, must be evaluated.

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“…What's more, the use of IFX or rituximab in refractory AIH patients may be still encouraged as some suggested that these regimens could improve the liver functions significantly. 33,34 About half of the patients relapse within 6 months after treatment and 80% of them relapse after 3-year drug withdrawal. Studies with long-term follow-up have suggested that prolonged treatment may be beneficial by reducing the disease recurrence in certain patients.…”

Section: Treatmentmentioning

confidence: 99%

Autoimmune hepatitis: Unveiling faces

Zhu

Han

2015

J of Digest Diseases

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Autoimmune hepatitis (AIH) is a complex multifactorial liver disease with unknown etiology. It may be induced by certain triggers that cause immune disorders and autoimmune attack in genetically susceptible individuals, which ultimately results in chronic persistent interface inflammation of the liver. The diagnosis of AIH is made based on comprehensive evaluation score system. All AIH patients should receive interventions and the mainstay therapy is prednisone alone or in combination with azathioprine. Further exploratory researches on refractory AIH have been developed. Liver transplantation is still the only effective option for patients with decompensated cirrhosis or hepatic failure.

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Infliximab as a rescue treatment in difficult-to-treat autoimmune hepatitis

Cited by 204 publications

References 31 publications

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

Review article: the prevention and reversal of hepatic fibrosis in autoimmune hepatitis

Autoimmune hepatitis: Unveiling faces

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