title: Mycophenolate mofetil as an alternative treatment for autoimmune hepatitis.
abstract: Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease characterized by hepatocellular inflammation, necrosis, and fibrosis, which can progress to cirrhosis and fulminant hepatic failure. The standard treatment for AIH includes corticosteroids alone or in combination with azathioprine. Although most patients achieve remission using the standard regimen, some patients do not respond due to either drug intolerance or refractory disease; in such cases alternative immunosuppressive agents should be explored. The second-line therapies are cyclophilin inhibitors such as cyclosporine A or tacrolimus, and nowadays mycophenolate mofetil (MMF) is widely used if azathioprine-based therapies are not tolerated. Although these are recommended as an alternative to the first-line regimen, there is insufficient evidence for the efficacy of second-line therapies, with the evidence based mainly on expert opinion. Therefore, we report an AIH patient receiving the standard regimen in whom remission did not occur due to side effects to azathioprine, but was successfully treated with MMF in combination with corticosteroids as an alternative to the standard regimen.
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Han Ah
authors.initials: HA
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Yura
authors.initials: Y
authors.lastname: Sim
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Yim
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu
mesh_terms: D000410:Alanine Transaminase / Q000032:analysis; D000505:Alopecia / Q000209:etiology; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000032:analysis; D001379:Azathioprine / Q000009:adverse effects; D005260:Female; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000201:enzymology / Q000473:pathology; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use*; D010198:Pancytopenia / Q000209:etiology; D011239:Prednisolone / Q000627:therapeutic use
chemical_list: D000903:Antibiotics, Antineoplastic; D011239:Prednisolone; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D009173:Mycophenolic Acid; D001379:Azathioprine
keywords: Autoimmune hepatitis; Azathioprine; Mycophenolate mofetil