title: Mycophenolate mofetil in autoimmune hepatitis patients not responsive or intolerant to standard immunosuppressive therapy.
abstract: OBJECTIVE
  The immunosuppressive treatment for autoimmune hepatitis (AIH) patients is prednisone and azathioprine. Ten percent to 20% of patients do not respond or are intolerant of standard treatment. The aim of this study was to assess the biochemical, histologic, and hematologic parameters during mycophenolate mofetil (MMF) treatment in AIH patients who did not respond to or were intolerant of prednisone and/or azathioprine.
  
  
  METHODS
  A retrospective study was performed of 15 AIH patients who received MMF either as monotherapy or in combination with prednisone after failure or intolerance of the initial regimen. Records were reviewed as to initial therapy, reasons why MMF was initiated, liver enzyme levels, histology on MMF, and complications.
  
  
  RESULTS
  The mean age was 60 +/- 15 years. All patients were started on MMF at 1 gram twice a day, 3 on MMF monotherapy, and 12 on prednisone and MMF. The average MMF treatment duration was 41 months. Alanine aminotransferase levels decreased significantly from 91.73 +/- 88.69 to 60.87 +/- 71.2 (P = .03) on MMF treatment. Inflammatory scores (2.59 +/- 0.97 to 1.14 +/- 1.21, P = .02) and Ishak fibrosis scores (4.10 +/- 1.37 to 2.5 +/- 1.51, P = .02) also decreased. No significant hematologic complications were noted during MMF treatment.
  
  
  CONCLUSIONS
  Administration of MMF, either as monotherapy or in combination with prednisone, results in biochemical and histologic improvement in AIH patients who are prednisone and/or azathioprine intolerant or resistant without the development of significant complications. MMF should be studied prospectively as an alternative agent in the treatment of autoimmune liver disease.
authors.affiliation: Division of Hepatology and Complex GI, Physicians Foundation, Department of Transplantation, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Ira
authors.initials: I
authors.lastname: Inductivo-Yu
authors.forename: Atoya
authors.initials: A
authors.lastname: Adams
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gish
authors.forename: Adil
authors.initials: A
authors.lastname: Wakil
authors.forename: Natalie H
authors.initials: NH
authors.lastname: Bzowej
authors.forename: R Todd
authors.initials: RT
authors.lastname: Frederick
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bonacini
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001706:Biopsy; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D011355:Prodrugs; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011355:Prodrugs; D011239:Prednisolone; D000410:Alanine Transaminase; D009173:Mycophenolic Acid