Long‐Term Observation of Cyclosporine as Second‐Line Therapy in Adults for Severe Acute Autoimmune Hepatitis

Noguchi, Fumie; Chu, Po–Sung; Taniki, Nobuhito; Yoshida, Aya; Morikawa, Rei; Yamaguchi, Akihiro; Ikura, Akihiko; Yamataka, Karin; Hoshi, Hitomi; Usui, Shingo; Ebinuma, Hirotoshi; Saito, Hidetsugu; Kanai, Takanori; Nakamoto, Nobuhiro

doi:10.1002/hep.31597

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…1). 15,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Details of the GRADE scoring across the studies per outcome are summarized in Supplementary Table 1. The quality of the evidence was rated very low for all outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Five were case reports [26][27][28]30,37 and six were case series. 15,29,31,32,43,44 In three case series, the patients treated with CYC were a portion of the entire case series. Data in these studies was variably reported for the entire case series, only the patients treated with CYC or only the pretreated patients.…”

Section: Cyclosporinementioning

confidence: 99%

“…In seven studies and the Dutch cohort, CYC dosage was adjusted based on through levels. 15,[27][28][29][30]32,43 Overall 59% of the patients reached remission, 22% had a response without remission, 12% had treatment failure on CYC, and 7% of CYC treatment responses could not be de-termined from the provided data. All 21 patients with known time to remission reached remission within 6 months after initiation of CYC.…”

Section: Cyclosporinementioning

confidence: 99%

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Calcineurin Inhibitors in the Treatment of Adult Autoimmune Hepatitis: A Systematic Review

Baven-Pronk¹,

Hew²,

Biewenga³

et al. 2022

J Clin Transl Hepatol

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Background and Aims:A considerable number of autoimmune hepatitis (AIH) patients completely or partially fail on first-line treatment. Several studies on the use of calcineurin inhibitors (CNIs) in the treatment of AIH have been published without focusing on indication. The aim was to assess the efficacy of CNIs in the treatment of adult AIH patients, specifically focusing on indication: first-line intolerant and with first-line insufficient response (failure to achieve or maintain remission), and with second versus third-line treatment. Methods: A literature search included studies on the use of CNIs in adult AIH. Patients with past or present use of CNIs from the Dutch AIH group cohort were added. The primary endpoint was biochemical remission while using CNIs. Secondary endpoints were biochemical response, treatment failure, and adverse effects. Results: Twenty studies from the literature and nine Dutch patients were included describing the use of cyclosporine in 59 and tacrolimus in 219 adult AIH patients. The CNI remission rate was 53% in patients with insufficient response to first-line treatment and 67% in patients intolerant to first-line treatment. CNIs were used as second-line treatment in 73% with a remission rate of 52% and as third-line treatment in 22% with a remission rate of 26%. Cyclosporine was discontinued in 13% and tacrolimus in 11% of patients because of adverse events. Conclusions: CNIs as rescue treatment in adult AIH patients are reasonably effective and safe both with insufficient response or intolerance to previous treatment. Prospective studies are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Cyclosporinementioning

confidence: 99%

Section: Cyclosporinementioning

confidence: 99%

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Calcineurin Inhibitors in the Treatment of Adult Autoimmune Hepatitis: A Systematic Review

Baven-Pronk¹,

Hew²,

Biewenga³

et al. 2022

J Clin Transl Hepatol

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“…With an overall response rate ＞75%, CsA, a calcineurin inhibitor, can be considered to be the agent of choice for immunosuppression in PRCA ( 39 ). CsA should also be considered as an alternative first line treatment for AIH, especially in pediatric patients ( 1 ), and it has also been reported for second line use in corticosteroid non-responders with severe acute-onset AIH in adults ( 40 ). Therefore, CsA may be considered if a relapse of PRCA or AIH is observed in the current case.…”

Section: Discussionmentioning

confidence: 99%

Concurrent <i>de novo</i> Thymoma-associated Paraneoplastic Type 1 Autoimmune Hepatitis and Pure Red Cell Aplasia after Thymectomy: A Case Report and Literature Review

et al. 2023

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The precise manipulation of immune tolerance is the holy grail of immunotherapies for both autoimmunity and cancer immunity. Thymomas are well known to be associated with autoimmune diseases. The exact mechanism by which autoreactivity is induced after thymectomy remains to be elucidated. We herein present the case of a 50-year-old lady with concurrent de novo type 1 autoimmune hepatitis (AIH) and pure red cell aplasia (PRCA), 1 month after undergoing a successful total thymectomy for combined squamous cell carcinoma and thymoma (Masaoka stage II). Corticosteroids yielded short-term effects for both AIH and PRCA. Literature on thymoma-associated AIH, an extremely rare immune-related comorbidity, was also reviewed.

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Autoimmune hepatitis: Challenges and novelties

Olivas

Rodríguez‐Tajes

Londoño

2022

Medicina Clínica (English Edition)

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Long‐Term Observation of Cyclosporine as Second‐Line Therapy in Adults for Severe Acute Autoimmune Hepatitis

Cited by 6 publications

References 6 publications

Calcineurin Inhibitors in the Treatment of Adult Autoimmune Hepatitis: A Systematic Review

Calcineurin Inhibitors in the Treatment of Adult Autoimmune Hepatitis: A Systematic Review

Concurrent <i>de novo</i> Thymoma-associated Paraneoplastic Type 1 Autoimmune Hepatitis and Pure Red Cell Aplasia after Thymectomy: A Case Report and Literature Review

Autoimmune hepatitis: Challenges and novelties

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