Rescue therapy with mycophenolate mofetil moderately effective in AIH
Use of mycophenolate mofetil (MMF) as rescue therapy in patients with autoimmune hepatitis (AIH) appears to be well tolerated, with moderate efficacy for inducing remission, according to data from the Tapestry study. However, response rates may be lower and infection rates higher in the presence of cirrhosis.
Researchers reviewed the medical records of 105 AIH patients who received MMF after an inadequate response or intolerance to standard therapy. Data of interest were baseline demographics, liver disease characteristics, initial therapy, MMF indications, treatment outcome and side effects.
Of the patients, 98 percent were previously treated with the combination of corticosteroids and thiopurine. Indications for MMF included treatment nonresponse (40 percent) and intolerance to therapy (60 percent).
After a median treatment duration of 12 weeks, 63 (60 percent) patients achieved biochemical remission with MMF. Treatment response in the group receiving MMF due to nonresponse to previous treatment was comparable to that in the group receiving MMF due to intolerance to standard therapy (57 vs 62 percent).
However, response rates were lower among patients with cirrhosis vs those without (47 vs 66 percent; p=0.07).
Serious adverse events (AEs) were reported in three patients (2.7 percent), including one death. AEs resulted in treatment discontinuation in 10 patients (9.2 percent).
Used extensively in organ transplantation settings, MMF exerts selective antiproliferative effects on T- and B-lymphocytes by inhibiting DNA synthesis. Evidence shows that MMF is a good second-line agent for patients who fail to respond to or who cannot tolerate azathioprine. [J Clin Exp Hepatol 2014;4:221–22]