Tacrolimus without or with the addition of conventional immunosuppressive treatment in juvenile autoimmune hepatitis.
OBJECTIVE
To investigate tacrolimus (Tac)-based treatment in juvenile autoimmune hepatitis (AIH). Twenty patients (13 girls; age, 8-17 years; median, 13.25 years) with AIH were treated with two daily oral doses of Tac. Six of them had advanced liver disease and/or cirrhosis.


METHODS
Drug concentrations in blood were measured regularly, and the target trough levels were 2.5-5 ng/mL. The patients were followed up for 1 year. Their clinical, biochemical, immunological and histological status was obtained at baseline and after 1 year.


RESULTS
In three cases, Tac alone led to complete remission. In 14 cases, additional low doses of prednisolone or azathioprine were used for a short time to achieve remission. In two cases, the treatment was discontinued: in one because of therapeutic failure, in another because of a suspected but unverified adverse event. Ten patients reported headache and/or recurrent abdominal pain. Two patients developed inflammatory bowel disease. Renal function remained intact.


CONCLUSIONS
Tac is a promising alternative first line of treatment for AIH. Although monotherapy with Tac is usually not sufficient to achieve complete remission, the prednisolone and azathioprine doses can be drastically reduced, and most of their side effects avoided.
Västra Götalands County Council, Childrens' Health Center, Västra Frölunda, Sweden. joanna.ramirez_marlaka@vgregion.se
Joanna Ramirez
JR
Marlaka
Nikos
N
Papadogiannakis
Björn
B
Fischler
Thomas H
TH
Casswall
Eva
E
Beijer
Antal
A
Németh
D000293:Adolescent; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D057194:Intention to Treat Analysis; D008297:Male; D011446:Prospective Studies; D016559:Tacrolimus / Q000008:administration & dosage / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D016559:Tacrolimus