Efficacy and safety profile of calcineurin inhibitor salvage therapy in autoimmune hepatitis

Efficacy and safety profile of calcineurin inhibitor salvage therapy in autoimmune hepatitis.

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Item Type: Article
Status: Published
Official URL: https://doi.org/10.1080/00365521.2020.1821764
Journal or Publication Title: Scandinavian Journal of Gastroenterology
Volume: 55
Number: 11
Page Range: pp. 1309-1317
Date: 2020
Divisions: Liver Injury and Cancer
Depositing User: General Admin
Identification Number: 10.1080/00365521.2020.1821764
ISSN: 0036-5521
Date Deposited: 04 Jan 2021 02:50
Abstract:

Background
As data is limited on the outcomes of calcineurin inhibitors (CNI) in autoimmune hepatitis (AIH), we evaluated the efficacy and safety of CNI in AIH patients who failed prior treatment(s).

Methods
A retrospective study was performed of AIH patients who received cyclosporine A (CsA) and/or tacrolimus (TAC) after prior treatment(s) failure. Records were reviewed for baseline demographic and clinical characteristics, and treatment outcomes. The primary outcome was biochemical remission.

Results: Thirty-three AIH patients received CNI across seven liver centers:17 received CsA, 21 TAC and 5 TAC after CsA failure/intolerance. 82% received CNI for an insufficient response to treatment(s). Overall, 48% of CNI treated patients achieved biochemical remission including 41% in prior non-responders and 83% in treatment intolerant patients. Remission rates with CNI as second-line and third-line therapy were 63% and 29% respectively. There were no baseline predictors of response to CNI on multivariate analysis. Eighteen (55%) patients developed significant side effects and 8 (24%) discontinued due to intolerance. Three patients required liver transplantation for decompensated cirrhosis and 6 patients died including one from malignancy possibly related to CNI.

Conclusion
CNI salvage therapy is well tolerated and moderately effective achieving remission in around 50% of AIH who failed standard therapy.

Creators:
Creators
Email
Roberts, Stuart K.
UNSPECIFIED
Strasser, Simone I.
UNSPECIFIED
Nicoll, Amanda J.
UNSPECIFIED
Kemp, William
UNSPECIFIED
Majeed, Ammar
UNSPECIFIED
Mitchell, Joanne
UNSPECIFIED
Stuart, Katherine
UNSPECIFIED
Gow, Paul
UNSPECIFIED
Sood, Siddharth
UNSPECIFIED
MacQuillan, Gerry
UNSPECIFIED
George, Jacob
UNSPECIFIED
Mitchell, Jonathan
UNSPECIFIED
McCaughan, Geoffrey W.
UNSPECIFIED
Last Modified: 04 Jan 2021 02:50
URI: https://eprints.centenary.org.au/id/eprint/760

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