Transplant immunosuppressive agents in non-transplant chronic autoimmune hepatitis: the Canadian association for the study of liver (CASL) experience with mycophenolate mofetil and tacrolimus.
BACKGROUND
Conventional treatment of autoimmune hepatitis consists of either prednisone alone or in combination with azathioprine. Ten to 20% of patients do not respond to or are intolerant of this treatment. Novel drug treatments include immunosuppressive drugs such as tacrolimus (TAC), mycophenolate mofetil (MMF), methotrexate and cyclosporine. We describe a multi-centre Canadian experience with MMF and TAC.


OBJECTIVE
To study a multi-centre patient population who had failed conventional therapy and were treated with non-conventional medical therapy for autoimmune hepatitis and document response.


METHODS
Members of the Canadian Association for the Study of Liver (CASL) obtained MMF from Hoffmann-La Roche Ltd, as part of a compassionate release program, were contacted for standardized data on patients with AIH who received MMF or TAC. Response definitions based on aminotransferase changes were: Complete response (CR)-sustained normalization, partial response (PR)-improvement by greater than 50%, non-response (NR)-less than 50% improvement and relapse (RP)-initial CR or PR followed by an increase in aminotransferases.


RESULTS
A total of 16 patients were identified: six in Ontario, one in Quebec, five in Alberta and four in British Columbia. Three were treated with TAC, eleven with MMF and two with combination MMF and TAC. CR was observed in 50%, PR in 12.5%, RP in 25% and NR occurred in 12.5%. The CR for MMF without TAC was approximately 64%.


CONCLUSIONS
MMF is effective and well tolerated by patients with autoimmune hepatitis who do not respond to, or are intolerant of, conventional immunosuppressive agents.
Chatur
Nazira
N
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Ramji
Alnoor
A
Bain
Vincent G
VG
Ma
Mang M
MM
Marotta
Paul J
PJ
Ghent
Cameron N
CN
Lilly
Leslie B
LB
Heathcote
E Jenny
EJ
Deschenes
Marc
M
Lee
Samuel S
SS
Steinbrecher
Urs P
UP
Yoshida
Eric M
EM
D000328:Adult; D000368:Aged; D002170:Canada; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D055502:Secondary Prevention; D016559:Tacrolimus / Q000627:therapeutic use*; D000637:Transaminases / Q000032:analysis; D016896:Treatment Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D000637:Transaminases; D009173:Mycophenolic Acid; D011241:Prednisone; D016559:Tacrolimus