In:
Alimentary Pharmacology & Therapeutics, Wiley, Vol. 49, No. 10 ( 2019-05), p. 1314-1322
Kurzfassung:
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.
Materialart:
Online-Ressource
ISSN:
0269-2813
,
1365-2036
DOI:
10.1111/apt.2019.49.issue-10
Sprache:
Englisch
Verlag:
Wiley
Publikationsdatum:
2019
ZDB Id:
2003094-0
SSG:
15,3
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