title: Infliximab as a rescue treatment in difficult-to-treat autoimmune hepatitis.
abstract: OBJECTIVE
  Autoimmune hepatitis is a chronic inflammatory liver disease that leads to liver cirrhosis and corresponding complications, if left untreated. Current standard treatment with azathioprine and prednisolone induces remission in the vast majority of patients. However, for those patients not responding to standard treatment or not tolerating these drugs, few alternatives can be used and their effectiveness might be limited. We sought to analyze the safety and efficacy of off-label treatment with infliximab in a cohort of eleven patients with difficult-to-treat autoimmune hepatitis.
  
  
  METHODS
  Patients with difficult-to-treat autoimmune hepatitis who could not be brought into remission with standard treatment, either due to drug intolerance or to insufficient drug impact, were treated off-label with infliximab for a minimum of six months. Patient files were reviewed retrospectively.
  
  
  RESULTS
  Treatment with infliximab led to reduction of inflammation, evidenced by a decrease in transaminases (mean AST prior treatment 475 U/L ± 466, mean AST during treatment 43 U/L ± 32) as well as in immunoglobulins (pretreatment mean IgG 24.8 mg/dl ± 10.1, mean IgG during treatment 17.38 mg/dl ± 6). Infectious complications occurred in seven out of eleven patients and close monitoring was necessary.
  
  
  CONCLUSIONS
  Infliximab may be considered as rescue therapy in patients with difficult-to-treat autoimmune hepatitis, albeit treatment may be associated with infectious complications.
authors.affiliation: I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. cweiler@uke.de
authors.forename: Christina
authors.initials: C
authors.lastname: Weiler-Normann
authors.forename: Christoph
authors.initials: C
authors.lastname: Schramm
authors.forename: Alexander
authors.initials: A
authors.lastname: Quaas
authors.forename: Christiane
authors.initials: C
authors.lastname: Wiegard
authors.forename: Claudia
authors.initials: C
authors.lastname: Glaubke
authors.forename: Nadine
authors.initials: N
authors.lastname: Pannicke
authors.forename: Sina
authors.initials: S
authors.lastname: Möller
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D007074:Immunoglobulin G; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000410:Alanine Transaminase