Beneficial response to mycophenolate mofetil by patients with autoimmune hepatitis who have failed standard therapy, is predicted by older age and lower immunoglobulin G and INR levels

Beneficial response to mycophenolate mofetil by patients with autoimmune hepatitis who have failed standard therapy, is predicted by older age and lower immunoglobulin G and INR levels.

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Item Type: Article
Status: Published
Official URL: https://doi.org/10.1111/apt.15248
Journal or Publication Title: Alimentary Pharmacology & Therapeutics
Volume: 49
Number: 10
Page Range: pp. 1314-1322
Date: 2019
Divisions: Liver Injury and Cancer
Depositing User: General Admin
Identification Number: 10.1111/apt.15248
ISSN: 02692813
Date Deposited: 21 Dec 2020 22:44
Abstract:

Background: Mycophenolate mofetil is a commonly used salvage therapy for patients with autoimmune hepatitis (AIH).

Aim: To evaluate the predictors of response to mycophenolate rescue therapy to facilitate clinical decision making.

Methods: We performed a retrospective observational cohort study of AIH patients managed in 17 major Australian liver centres who received mycophenolate after an inadequate response or intolerance to corticosteroids with/without thiopurine(s). Baseline demographic, clinical and laboratory variables were compared between responders and nonresponders. A multivariable logistic regression model was developed using forward selection to identify independent predictors of treatment response.

Results: A total of 105 patients received mycophenolate rescue therapy of whom 63 (60%) achieved biochemical remission. On univariable analysis, older age (P = 0.003), INR < 1.1 (P = 0.02), and lower immunoglobulin gamma (IgG; P < 0.002) levels were associated with treatment response, while no association was found with cirrhosis status (P = 0.07) or treatment indication (P = 0.63). On multivariable analysis, lower pre-treatment serum IgG level (P = 0.01), higher age at commencing mycophenolate (P = 0.01) and higher INR (P = 0.03) were the only significant independent predictors. An IgG level <17 g/L had a positive and negative predictive value for response of 71% and 60% respectively, while age ≥54 years when commencing mycophenolate had a positive and negative predictive value for response of 80% and 59% respectively.

Conclusion: Mycophenolate remains an excellent treatment option for patients with AIH refractory to or intolerant of standard therapy with those most likely to benefit being older and/or having lower pre-treatment IgG levels.

© 2019 John Wiley & Sons Ltd.

Creators:
Creators
Email
Nicoll, Amanda J.
UNSPECIFIED
Roberts, Stuart K.
UNSPECIFIED
Lim, Ricky
UNSPECIFIED
Mitchell, Joanne
UNSPECIFIED
Weltman, Martin
UNSPECIFIED
George, Jacob
UNSPECIFIED
Wigg, Alan
UNSPECIFIED
Stuart, Katherine
UNSPECIFIED
Gow, Paul
UNSPECIFIED
MacQuillan, Gerry
UNSPECIFIED
Tse, Edmund
UNSPECIFIED
Levy, Miriam
UNSPECIFIED
Sood, Siddharth
UNSPECIFIED
Zekry, Amany
UNSPECIFIED
Cheng, Wendy
UNSPECIFIED
Mitchell, Jonathan
UNSPECIFIED
Skoien, Richard
UNSPECIFIED
Sievert, William
UNSPECIFIED
Strasser, Simone I.
UNSPECIFIED
McCaughan, Geoffrey W.
UNSPECIFIED
Last Modified: 21 Dec 2020 22:44
URI: https://eprints.centenary.org.au/id/eprint/226

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