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Title: Efficacy and safety profile of calcineurin inhibitor salvage therapy in autoimmune hepatitis.
Austin Authors: Roberts, Stuart K;Strasser, Simone I;Nicoll, Amanda J;Kemp, William;Majeed, Ammar;Mitchell, Joanne;Stuart, Katherine;Gow, Paul J ;Sood, Siddharth ;MacQuillan, Gerry;George, Jacob;Mitchell, Jonathan;McCaughan, Geoffrey W
Affiliation: Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney, Australia
Centenary Research Institute, Sydney, Australia
Sunshine Coast General Hospital, Nambour, Australia
The Alfred Hospital, Melbourne, Australia
Monash University, Melbourne, Australia
Eastern Health, Melbourne, Australia
Sir Charles Gairdner Hospital, Perth, Australia
Royal Prince Alfred Hospital, Sydney, Australia
University of Sydney, Sydney, Australia
Royal Melbourne Hospital, Melbourne, Australia
Austin Health
Princess Alexandra Hospital, Brisbane, Australia
Issue Date: Nov-2020
Date: 2020-10-17
Publication information: Scandinavian Journal of Gastroenterology 2020; 55(11): 1309-1317
Abstract: 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). 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. CNI salvage therapy is well tolerated and moderately effective achieving remission in around 50% of AIH who failed standard therapy.
DOI: 10.1080/00365521.2020.1821764
Journal: Scandinavian Journal of Gastroenterology
PubMed URL: 33070650
Type: Journal Article
Subjects: Tacrolimus
autoimmune hepatitis
refractory immunosuppression
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