Tacrolimus and Mycophenolate Mofetil as Second-Line Therapies for Pediatric Patients with Autoimmune Hepatitis

Efe, Cumali; Taii, Haider Al; Ytting, Henriette; Aehling, Niklas; Bhanji, Rahima A.; Hagström, Hannes; Pürnak, Tuğrul; Muratori, Luigi; Werner, Mårten; Klintman, Daniel; Schiano, Thomas D.; Montano‐Loza, Aldo J.; Berg, Thomas; Larsen, Fin Stolze; Alkhouri, Naim; Özaslan, Ersan; Heneghan, Michael A.; Yoshida, Eric M.; Wåhlin, Staffan

doi:10.1007/s10620-018-5011-x

Cited by 34 publications

(32 citation statements)

References 23 publications

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“…Prednisolone in combination with azathioprine or 6-mercaptopurine (6-MP) was used in 26% of patients, prednisolone monotherapy in 9%, and budesonide monotherapy in 2%. (22) Biochemical remission was achieved in 59% of Delgado et al, (40) Israel, multicenter Woynarowski et al, (38) (pediatrics subgroup Efe et al, (44) 13 centers Hlivko et al, (43) USA, Virginia Commonwealth Campsen et al, (26) USA,…”

Section: Studies Selected For Qualitative Analysismentioning

confidence: 99%

“…The SR identified four comparative observational studies and no RCTs in patients who had failed to achieve remission using prednisone or prednisolone with or without azathioprine. Two studies (41,42) met the criteria for inclusion in the meta-analysis, and all four comparative observational studies met the criteria for qualitative analysis of treatment with MMF versus the calcineurin inhibitor TAC (41)(42)(43)(44) (Fig. 2).…”

Section: Sr2 Pico Question: In Patients With Aih Treated With Prednismentioning

confidence: 99%

“…One was an analysis of the comparative efficacy of MMF and TAC in 38 pediatric patients with AIH. (44) The other was a retrospective analysis of 29 patients with AIH who had been treated with MMF as initial therapy (17 patients) or as secondary therapy after failure of SOC immunosuppression (12 patients). (43) In the pediatric study, treatment with MMF or TAC was able to maintain similar rates of biochemical remission (normal serum aminotransferase and IgG levels) after withdrawal of SOC immunosuppression (89% versus 88%).…”

Section: Studies Selected For Qualitative Analysismentioning

confidence: 99%

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Immunosuppressive Treatment Regimens in Autoimmune Hepatitis: Systematic Reviews and Meta‐Analyses Supporting American Association for the Study of Liver Diseases Guidelines

Vierling¹,

Kerkar²,

Czaja³

et al. 2020

Hepatology

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Section: Studies Selected For Qualitative Analysismentioning

confidence: 99%

Section: Sr2 Pico Question: In Patients With Aih Treated With Prednismentioning

confidence: 99%

Section: Studies Selected For Qualitative Analysismentioning

confidence: 99%

See 1 more Smart Citation

Immunosuppressive Treatment Regimens in Autoimmune Hepatitis: Systematic Reviews and Meta‐Analyses Supporting American Association for the Study of Liver Diseases Guidelines

Vierling¹,

Kerkar²,

Czaja³

et al. 2020

Hepatology

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“…Diagnostic criteria have now been codified, diagnostic scoring systems have been developed to support clinical judgment, autoantibody profiles have been expanded, patient subgroups have been defined by serological markers, treatment endpoints have been refined, and new first‐line (budesonide and azathioprine) and second‐line (mycophenolate mofetil, 6‐mercaptopurine, tacrolimus, cyclosporine) treatment regimens have been introduced (Figs. and ).…”

mentioning

confidence: 99%

“…[65][66][67] Furthermore, anti-liver/kidney microsome type 1 antibody (anti-LKM1) in patients with type 2 AIH reacted against a 13-amino acid sequence in cytochrome P450 2D6 (CYP2D6) that was different from the amino acid sequences recognized by anti-LKM1 in some patients with chronic hepatitis C. 68 The findings supported the concept that the LKM1 antibodies were generated in different diseases responding to different epitopes. 68 Diagnostic criteria have now been codified, 40,69-71 diagnostic scoring systems have been developed to support clinical judgment, 40 review defined by serological markers, 75 treatment endpoints have been refined, 69,76 and new first-line (budesonide and azathioprine) 77 and second-line (mycophenolate mofetil, 6-mercaptopurine, tacrolimus, cyclosporine) [78][79][80][81][82] treatment regimens have been introduced ( Figs. 1 and 7).…”

mentioning

confidence: 99%

Autoimmune Hepatitis: Surviving Crises of Doubt and Elimination

Czaja

2020

Clinical Liver Disease

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Autoimmune hepatitis (AIH) has survived doubts about its existence [1][2][3][4] and clinical and pathological definitions that have overly restricted its clinical phenotype. 5-10 AIH was originally considered to be a disease predominantly of young women associated with hypergammaglobulinemia 1,6-8 and defined by one or the other of its major pathological configurations ("chronic persistent hepatitis" versus "chronic active hepatitis"). 9,10 AIH has also survived proposals in favor of putative causative agents that have threatened its validity, [11][12][13][14][15][16][17][18] the continuing lack of a signature marker to define its identity, [19][20][21][22] and reduced investigational and funding priorities because of its rarity. 23 The emergence of AIH from its origins as "lupoid hepatitis," 24,25 "chronic active liver disease" (CALD), 26,27 and "hepatitis B surface antigen (HBsAg)-negative chronic active hepatitis" 13,28 has constituted a learning process that has overcome hurdles of preconceptions, misunderstandings, skepticisms, and biases (Fig. 1), and it has exemplified a maturation process that has involved an international cadre of investigators. Ironically, the attempt that was made by an eminent group of European pathologistsnicknamed by Dame Sheila Sherlock "The Gnomes of Zurich" 29 -to codify the confusing nomenclature of

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More Than Meets the Eye?

Dorsey

Oloruntoba

Pendse

et al. 2021

Clinical Liver Disease

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A 37-year-old African American man with a history of primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), and ulcerative colitis (UC) presented to the emergency department with jaundice and fatigue. He was originally diagnosed with PSC on the basis of magnetic resonance cholangiopancreatography (MRCP) 8 years ago. He subsequently had increasing aspartate aminotransaminase (AST) and alanine aminotransferase (ALT) 1 year prior to his current presentation with ALT 145 U/L, AST 92 U/L, alkaline phosphatase (ALP) 245 U/L, and total bilirubin (TB) 2.0 mg/dL. A liver biopsy at that time showed moderate interface and lobular hepatitis, as well as focal areas of attenuated bile ducts and associated fibrosis consistent with a diagnosis of PSC/AIH overlap. He was started on prednisone and azathioprine (AZA), although he was inconsistent in taking these medications secondary to financial reasons. He was seen in clinic 1 month prior to the current visit and at that time laboratory results were AST 254 U/L, ALT 275 U/L, ALP 675 U/L, and TB 16.2 mg/dL. His AZA was resumed at a dosage of 75 mg/day, and his prednisone dose was increased.At the current visit, he described worsening jaundice, dark urine, fatigue, and pruritus. He also endorsed having one episode of nonbloody emesis but denied abdominal pain or diarrhea.He denied alcohol use or drug use. His outpatient medications at the time of the clinic visit included AZA 150 mg daily, losartan/hydrochlorothiazide 50/12.5 mg daily, mesalamine 1200 mg daily, prednisone 40 mg daily, omeprazole 40 mg daily, and ergocalciferol 50,000 units weekly. He denied taking any herbal medications or over-thecounter medications. He endorsed compliance with prednisone and AZA during the last month. He had increased

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Tacrolimus and Mycophenolate Mofetil as Second-Line Therapies for Pediatric Patients with Autoimmune Hepatitis

Abstract: Long-term therapy with MMF or tacrolimus was generally well tolerated by pediatric patients with AIH. Both MMF and tacrolimus had excellent efficacy in patients intolerant to corticosteroid or azathioprine. Tacrolimus might be more effective than MMF in patients failing previous therapy.

Cited by 34 publications

References 23 publications

Immunosuppressive Treatment Regimens in Autoimmune Hepatitis: Systematic Reviews and Meta‐Analyses Supporting American Association for the Study of Liver Diseases Guidelines

Immunosuppressive Treatment Regimens in Autoimmune Hepatitis: Systematic Reviews and Meta‐Analyses Supporting American Association for the Study of Liver Diseases Guidelines

Autoimmune Hepatitis: Surviving Crises of Doubt and Elimination

More Than Meets the Eye?

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