The use of tacrolimus in refractory autoimmune hepatitis in children and adults: a single center experience

Taii, Haider Al; Hanouneh, Mohamad; Hanouneh, Ibrahim A.; López, Rocío; Zein, Nizar N.; Alkhouri, Naim

doi:10.1080/00365521.2016.1236398

Cited by 21 publications

(15 citation statements)

References 3 publications

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“…The reported efficacy was good in a total number of 80 patients (Table 3 ). Two prospective open-label trials from the ‘90s are available, both in naïve patients[ 133 , 136 ] (Table 3 ). The oldest one included 21 adult patients[ 133 ], with a follow up of 1 year, after which a liver biopsy was repeated, but histological results are not reported.…”

Section: Alternative Treatmentsmentioning

confidence: 99%

See 1 more Smart Citation

Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments

Beretta‐Piccoli

Mieli‐Vergani

Vergani

2017

WJG

119

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%

“…The second prospective trial in naïve patients included seven adult subjects and used lower tacrolimus doses combined with 20 mg/d of prednisolone. Transaminase levels, albumin, bilirubin and prothrombin time significantly improved in 6/7 patients[ 136 ].…”

Section: Alternative Treatmentsmentioning

confidence: 99%

Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments

Beretta‐Piccoli

Mieli‐Vergani

Vergani

2017

WJG

119

102

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“…It has been demonstrated that mycophenolate mofetil (MMF) ( 5 , 44 – 51 ), methotrexate ( 52 ), 6-mercaptopurine ( 53 ), allopurinol ( 54 , 55 ), tacrolimus ( 8 , 45 , 56 – 59 ) and everolimus ( 60 ) are effective and well-tolerated in patients with AIH. Torisu et al ( 61 ) indicated that UDCA monotherapy may be considered for treatment of patients with AIH with a serum ALT level of <200 IU/l.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and tolerability of treatments for adult autoimmune hepatitis: A systematic review and network meta‑analysis

et al. 2018

Exp Ther Med

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The most suitable treatment regimen for autoimmune hepatitis (AIH) in adults remains unknown and requires further investigation. The current study therefore aimed to integrate evidence to provide hierarchies of the comparative efficacies of treatments measured by clinical and biochemical remission. A Bayesian-framework network meta-analysis of randomized controlled trials (RCTs) was preformed to compare eight treatments for AIH. Eligible RCTs were identified by searching Embase, Pubmed and the Cochrane Library for publications between 1966 and April 2017. All outcomes were independently extracted from the included studies by two authors. A total of six RCTs were subsequently included in the current study. The network of comparisons on remission indicated that patients treated with prednisone (pred) experienced significantly increased rates of remission compared with those treated with azathioprine [AZA; odds ratio (OR), 0.21; 95% confidence interval (CI), 0.06–0.71] and budesonide (bude) + AZA significantly increased remission compared with placebo treatment (OR, 36.66; 95% CI, 1.40–962.49) or AZA (OR, 10.30; 95% CI, 1.50–70.70). Based on the cumulative ranking probabilities, bude + AZA (89.4) was ranked first, pred (69.1) was ranked second, pred + AZA (63.2) was ranked third and placebo (7.8) treatment was ranked last. Bude + AZA may be the most appropriate candidate for the treatment of non-cirrhotic patients. However, bude + AZA as frontline therapy for AIH requires more large-scale studies with a longer duration of follow-up histology and a focus on dose-response. Additionally, development of other prospective treatments, which may be used as alternative therapy or first line therapy, and their subsequent evaluation in clinical RCTs is required.

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“…Just as cyclosporine, TAC inhibits intracellular calcineurin activity, ultimately leading to a lack of T-cell activation [73]. Several smaller cohorts of up to 21 patients state a generally good response to TAC, between 69 and 100% of patients [49,[84][85][86][87][88][89]. Aqel et al [85] reported follow-up liver biopsies in 7 patients, demonstrating improvement of necroinflammatory activity score in all and fibrosis score in 3 patients.…”

Section: Tacrolimusmentioning

confidence: 99%

Autoimmune Hepatitis: a Review of Established and Evolving Treatments

Bischoff

Yesmembetov

Antoni

et al. 2020

JGLD

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Autoimmune hepatitis (AIH) is a necroinflammatory liver disease commonly presenting with a fluctuating course of activity, presence of circulating autoantibodies, hyperglobulinemia of IgG, and/or response to immunosuppressive drugs. However, the disease displays a considerable heterogeneity. No single clinical or biochemical test may establish diagnosis of AIH. Thus, diagnosis still requires extensive clinical evaluation and experience. Prednisolone and azathioprine are considered standard treatment leading to remission in most patients. However, this standard treatment may not be effective in some patients or not be feasible due to one of these drugs. Over the past two decades additional immunosuppressant drugs for the treatment of AIH have been evaluated and have significantly extended the therapeutic spectrum. Among those novel drugs are mycophenolate mofetil, tacrolimus, everolimus, 6-mercaptopurine, infliximab, rituximab and several others. In this review we summarize the current standard of therapy but also efforts of providing novel therapeutic strategies to AIH patients.

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The use of tacrolimus in refractory autoimmune hepatitis in children and adults: a single center experience

Cited by 21 publications

References 3 publications

Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments

Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments

Comparative efficacy and tolerability of treatments for adult autoimmune hepatitis: A systematic review and network meta‑analysis

Autoimmune Hepatitis: a Review of Established and Evolving Treatments

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