title: Use of sirolimus in the treatment of refractory autoimmune hepatitis.
abstract: BACKGROUND
  Corticosteroids and azathioprine are widely accepted as the initial therapy for autoimmune hepatitis. However, the disease is refractory to steroids in about 10%-20% of patients, for whom currently there is no standardized treatment. Here we describe our experience with sirolimus in treatment of steroid refractory autoimmune hepatitis.
  
  
  METHODS
  This is a longitudinal follow-up study. Between November 2007 and January 2014, 5 subjects with steroid refractory autoimmune hepatitis were treated with sirolimus at our institution.
  
  
  RESULTS
  A response, defined as a sustained >50% fall in alanine aminotransferase (ALT) levels, was achieved in 4/5 patients. A complete response, sustained normalization of ALT levels, was achieved in 2/5 patients. The need for steroids was significantly reduced in all patients (P < .05).
  
  
  CONCLUSIONS
  In this small series, sirolimus appears to be useful in the treatment of patients with steroid refractory autoimmune hepatitis.
authors: Department of Medicine and Liver Research Institute, University of Arizona College of Medicine, Tucson.
authors: Hemant
authors: H
authors: Chatrath
authors: Department of Medicine and Liver Research Institute, University of Arizona College of Medicine, Tucson.
authors: Larissa
authors: L
authors: Allen
authors: Department of Medicine and Liver Research Institute, University of Arizona College of Medicine, Tucson. Electronic address: tboyer@deptofmed.arizona.edu.
authors: Thomas D
authors: TD
authors: Boyer
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001379:Azathioprine / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D004351:Drug Resistance; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019693:Hepatitis, Autoimmune / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D020123:Sirolimus / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D009173:Mycophenolic Acid; D001379:Azathioprine; D001663:Bilirubin; D011241:Prednisone; D020123:Sirolimus
keywords: Autoimmune hepatitis; Sirolimus; Steroid-refractory