title: Role of mycophenolate mofetil for the treatment of autoimmune hepatitis-an observational study.
abstract: BACKGROUND
  Eighty percent (80%) of patients with Autoimmune hepatitis (AIH) respond to a combination of prednisolone and Azathioprine (AZA). Choice of treatment is limited for those who do not respond to this standard therapy. We evaluated the role of Mycophenolate mofetil (MMF) as a second line therapy in AIH.
  
  
  METHODS
  A retrospective observational study was carried out on all patients who received MMF for AIH.
  
  
  RESULTS
  Twenty out of 117 patients with AIH received MMF due to AZA intolerance (18 patients) or refractory disease (2 patients). Median age of the study patients was 56 (18-79) years, Male, n = 3 (15%) and Female, n = 18 (85%). After a median follow-up period of 47 (5-83) months, 14 (73.6%) patients were still on MMF with biochemical remission, including 4 out of 5 patients with cirrhosis. One patient was lost to follow-up. Three patients were intolerant of MMF due to adverse events, and two had disease refractory to MMF. Both these patients with refractory disease to MMF were initially unresponsive to AZA therapy.
  
  
  CONCLUSIONS
  MMF is a safe second line agent in patients with autoimmune hepatitis including those with cirrhosis.
authors.affiliation: Institute of Liver Disease and Transplantation, Global Hospitals, Chennai, India.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Jothimani
authors.affiliation: The South West Liver Unit, Plymouth Hospitals, Derriford Road, Plymouth, Devon PL6 8DH, United Kingdom.
authors.forename: Mathew E
authors.initials: ME
authors.lastname: Cramp
authors.affiliation: The Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom.
authors.forename: Tim J S
authors.initials: TJ
authors.lastname: Cross
keywords: AIH, autoimmune hepatitis; AZA, azathioprine; MMF, mycophenolate mofetil; autoimmune hepatitis; azathioprine; mycophenolate mofetil; non-responders