Efficacy of tacrolimus in the treatment of steroid refractory autoimmune hepatitis.
BACKGROUND
Autoimmune hepatitis (AIH) is an immune mediated chronic liver disease with a prevalence of 17 cases/100,000. Resistance to the standard treatment of AIH (prednisone and azathioprine) occurs in 15% to 20%. There is currently no standard treatment of patients with steroid refractory AIH.


OBJECTIVE
Determine the efficacy of tacrolimus in the treatment of steroid refractory AIH.


METHODS
This is a retrospective study evaluating the efficacy of Tacrolimus in the treatment of steroid refractory AIH.


RESULTS
Between October 1998 and February 2002, 11 patients with steroid refractory AIH were treated with tacrolimus. Mean age was 63 years. Median duration of steroid treatment before starting tacrolimus was 9 months. Median duration of tacrolimus treatment was 25 months. Median follow-up period was 16 months. Median baseline ALT, AST were 77 U/L and 68 U/L and became 21 U/L and 32 U/L respectively at end of follow-up (P = 0.005 and 0.01 respectively). Significant weight reduction was seen in all patients (P = 0.02). Tacrolimus treatment was safe and well tolerated.


CONCLUSIONS
Use of low dose tacrolimus led to successful biochemical and histologic remission and weaning off prednisone in patients with steroid refractory AIH. This data supports further studies in evaluating the use of tacrolimus in the treatment of AIH.
Aqel
Bashar A
BA
Division of Hepatology and Gastroenterology Mayo Clinic, Jacksonville, Florida 32216, USA.
Machicao
Victor
V
Rosser
Barry
B
Satyanarayana
Raj
R
Harnois
Denise M
DM
Dickson
Rolland C
RC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001379:Azathioprine / Q000627:therapeutic use; D001706:Biopsy; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D013256:Steroids; D001379:Azathioprine; D011241:Prednisone; D016559:Tacrolimus