Remission with ursodeoxycholic acid of type 1 autoimmune hepatitis resistant to azathioprine and steroids

Duclos‐Vallée, Jean‐Charles; Martino, Vincent Di; Cazier, A; Ballot, Éric; Johanet, Catherine; Yamamoto, Ana Maria; Émile, Jean-François; Guettier, Catherine; Coutarel, Pierre; Cadranel, Jean–François

doi:10.1016/s0399-8320(05)82185-2

Cited by 6 publications

(3 citation statements)

References 25 publications

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“…A systematic review of the published clinical data on pharmacological treatments different from prednisone and azathioprine is provided in this section. Treatments for whom there are only anecdotal data are not discussed cyclophosphamide[ 59 ], methotrexate[ 60 - 62 ], ursodeoxycholic acid[ 63 - 69 ], etanercept[ 70 ], plasma exchange[ 71 ], intravenous immunoglobulin[ 72 ], leukapheresis[ 73 ], chloroquine[ 74 ], thymostimulin[ 75 ], deflazacort[ 76 , 77 ], saireito[ 78 ], sympathomimetic amines[ 79 ], glycyrrhizin[ 80 ], fenofibrate[ 81 ].…”

Section: Alternative Treatmentsmentioning

confidence: 99%

Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments

Beretta‐Piccoli

Mieli‐Vergani

Vergani

2017

WJG

118

102

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Autoimmune hepatitis is a rare chronic inflammatory liver disease, affecting all ages, characterised by elevated transaminase and immunoglobulin G levels, positive autoantibodies, interface hepatitis at liver histology and good response to immunosuppressive treatment. If untreated, it has a poor prognosis. The aim of this review is to summarize the evidence for standard treatment and to provide a systematic review on alternative treatments for adults and children. Standard treatment is based on steroids and azathioprine, and leads to disease remission in 80%-90% of patients. Alternative first line treatment has been attempted with budesonide or cyclosporine, but their superiority compared to standard treatment remains to be demonstrated. Second-line treatments are needed for patients not responding or intolerant to standard treatment. No randomized controlled trials have been performed for second-line options. Mycophenolate mofetil is the most widely used second-line drug, and has good efficacy particularly for patients intolerant to azathioprine, but has the major disadvantage of being teratogenic. Only few and heterogeneous data on cyclosporine, tacrolimus, everolimus and sirolimus are available. More recently, experience with the anti-tumour necrosis factor-alpha infliximab and the anti-CD20 rituximab has been published, with ambivalent results; these agents may have severe side-effects and their use should be restricted to specialized centres. Clinical trials with new therapeutic options are ongoing.

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Section: Alternative Treatmentsmentioning

confidence: 99%

Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments

Beretta‐Piccoli

Mieli‐Vergani

Vergani

2017

WJG

118

102

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“…Biochemical and histologic remission of AIH have been reported in case reports of patients on UDCA monotherapy. 34 , 35 Considering the relatively benign side effect profile of UDCA, its use may be considered in patients with lower disease activity in an attempt to induce remission. In patients with more active AIH, UDCA may permit dosage reduction of immunosuppressants, particularly corticosteroids.…”

Section: Resultsmentioning

confidence: 99%

Ursodeoxycholic acid in treatment of non-cholestatic liver diseases: A systematic review

Reardon

Hussaini

Alsahafi

et al. 2016

JCTH

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Aims: To systematically evaluate the literature for evidence to support the use of bile acids in non-cholestatic liver conditions.Methods: Searches were conducted on the databases of Medline (1948-March 31, 2015), Embase (1980-March 31, 2015) and the Cochrane Central Register of Controlled Trials, and on Google and Google Scholar to identify articles describing ursodeoxycholic acid (UDCA) and its derivatives for non-cholestatic hepatic indications. Combinations of the following search terms were used: ursodeoxycholic acid, ursodiol, bile acids and/or salts, non alcoholic fatty liver, non alcoholic steatohepatitis, fatty liver, alcoholic hepatitis, alcohol, liver disease, autoimmune, autoimmune hepatitis, liver transplant, liver graft, transplant rejection, graft rejection, ischemic reperfusion injury, reperfusion injury, hepatitis B, hepatitis C, viral hepatitis, chronic hepatitis, acute hepatitis, transaminases, alanine transaminase, liver enzymes, aspartate aminotransferase, gamma-glutamyl transferase, gamma-glutamyl transpeptidase, bilirubin, alkaline phosphatase. No search limits were applied. Additionally, references of the included studies were reviewed to identify additional articles.Results: The literature search yielded articles meeting inclusion criteria for the following indications: non-alcoholic fatty liver disease (n = 5); alcoholic liver disease (n = 2); autoimmune hepatitis (n = 6), liver transplant (n = 2) and viral hepatitis (n = 9). Bile acid use was associated with improved normalization of liver biochemistry in non-alcoholic fatty liver disease, autoimmune hepatitis and hepatitis B and C infections. In contrast, liver biochemistry normalization was inconsistent in alcoholic liver disease and liver transplantation. The majority of studies reviewed showed that normalization of liver biochemistry did not correlate to improvement in histologic disease. In the prospective trials reviewed, adverse effects associated with the bile acids were limited to minor gastrointestinal complaints (most often, diarrhea) and did not occur at increased frequency as compared to controls. As administration of bile acids was often limited to durations of 12 months or less, long-term side effects for non-cholestatic indications cannot be excluded.Conclusions: Based on the available literature, bile acids cannot be widely recommended for non-cholestatic liver diseases at present.

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“…19 Furthermore, partial and complete remission of AIH could occur during UDCA therapy. 20,21 We reported patients having severe flares-up of hepatitis. It cannot be excluded that other PBC patients may also present with minor forms of AIH that, together with the cholestatic process, could contribute to the deterioration of liver function.…”

Section: Discussionmentioning

confidence: 99%

Development of autoimmune hepatitis in patients with typical primary biliary cirrhosis

et al. 2006

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Primary biliary cirrhosis (PBC)-autoimmune hepatitis (AIH) overlap syndrome is a clinical entity characterized by the occurence of both conditions at the same time in the same patient. In addition to PBC-AIH overlap syndrome, transitions from one autoimmune disease to another have been reported, but no systematic series have been published. We report a series of 12 patients with consecutive occurrence of PBC and AIH (i.e., PBC followed by AIH). Among 282 PBC patients, 39 were identified who fulfilled criteria for probable or definitive AIH. AIH developed in 12 patients (4.3%). The baseline characteristics of the patients were similar to those of patients with classical PBC. Time elapsed between the diagnosis of PBC and the diagnosis of AIH varied from 6 months to 13 years. Patients with multiple flares of hepatitis at the time of diagnosis of AIH had cirrhosis on liver biopsy. Ten patients were given prednisone ؎ azathioprine; short-term as well as sustained remissions were obtained in 8 of these, while two had multiple relapses and eventually died 8 and 7 years after diagnosis of AIH. In conclusion, the development of superimposed AIH could not be predicted from baseline characteristics and initial response to UDCA therapy. If not detected early, superimposed AIH can result in rapid progression toward cirrhosis and liver failure in PBC patients. (HEPATOLOGY 2006;44:85-90.)

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Remission with ursodeoxycholic acid of type 1 autoimmune hepatitis resistant to azathioprine and steroids

Cited by 6 publications

References 25 publications

Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments

Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments

Ursodeoxycholic acid in treatment of non-cholestatic liver diseases: A systematic review

Development of autoimmune hepatitis in patients with typical primary biliary cirrhosis

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