霉酚酸酯作为自身免疫性肝炎的二线治疗——一项回顾性单中心分析

IF 4.7 Q2 IMMUNOLOGY
Mirjam Kolev , Stefan Diem , Lara Diem , Susana G. Rodrigues , Annalisa Berzigotti , Guido Stirnimann , Nasser Semmo
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引用次数: 1

摘要

大多数自身免疫性肝炎患者对类固醇和硫唑嘌呤的标准治疗有反应。虽然这种疾病如果不治疗通常是致命的,但对治疗反应良好的患者预后良好。然而,由于不耐受或对一线治疗反应不足,大约20%的患者需要二线治疗。虽然霉酚酸酯(MMF)用于硫唑嘌呤不耐受患者的数据令人鼓舞,但对于对一线治疗反应不足的患者,MMF的益处似乎较小,但有关这一问题的分析数据有限。目的评价MMF作为AIH患者二线治疗的疗效和安全性。方法回顾性分析2000年至2022年接受治疗的AIH患者的单中心数据库。在包括最后一次随访在内的不同时间点评估临床、免疫学和生化指标。结果共发现144例AIH患者。144例AIH患者中有50例(35%)接受了MMF治疗。40例(80%)患者因一线治疗不耐受而接受MMF治疗,10例(20%)患者因一线治疗反应不足而接受MMF治疗。MMF单药治疗的缓解率在不耐受组为81.5%,而在反应不足组为30%。由于反应不足,患者转而使用MMF,更经常需要额外的强的松龙剂量高于5mg /天,转而使用三线治疗或联合治疗,以实现疾病控制。结论对一线治疗不耐受的患者,绝大多数在MMF治疗下病情控制良好。由于对一线治疗反应不足,转而使用MMF的患者的疗效明显较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Mycophenolate mofetil as second line treatment in autoimmune hepatitis – A retrospective single center analysis

Mycophenolate mofetil as second line treatment in autoimmune hepatitis – A retrospective single center analysis

Mycophenolate mofetil as second line treatment in autoimmune hepatitis – A retrospective single center analysis

Mycophenolate mofetil as second line treatment in autoimmune hepatitis – A retrospective single center analysis

Background

Most patients with autoimmune hepatitis respond to standard treatment with steroids and azathioprine. While the disease is usually fatal if untreated, patients who respond well to therapy have an excellent prognosis. Nevertheless, second-line treatment is necessary in approximately 20% of patients, due to either intolerance or insufficient response to first line treatment.

While data for mycophenolate mofetil (MMF) in patients intolerant to azathioprine is encouraging, MMF seems of less benefit in patients with insufficient response to first line treatment, but analyzed data on this issue is limited.

Aim

To evaluate the efficacy and safety of MMF as a second-line therapy in patients with AIH.

Methods

Retrospective analysis of a monocentric database of AIH patients who received medical care from 2000 to 2022. Clinical, immunological and biochemical parameters were assessed at different time points including last follow-up.

Results

Overall, 144 patients with AIH were identified. Fifty out of 144 (35%) AIH patients received MMF. Forty (80%) received MMF due to first line treatment intolerance, while ten (20%) due to insufficient response to first line treatment.

Remission with MMF monotherapy was 81.5% in the intolerance group versus 30% in the insufficient response group. Patients switched to MMF because of an insufficient response, more often needed additional prednisolone doses higher than 5 mg/day, a switch to third-line treatment or combination regiments, to achieve disease control.

Conclusions

Patients treated with MMF because of intolerance to first line treatment show a good disease control under MMF in the majority of cases. Efficacy is considerably lower in the patients switched to MMF because of an insufficient response to first line treatment.

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来源期刊
Journal of Translational Autoimmunity
Journal of Translational Autoimmunity Medicine-Immunology and Allergy
CiteScore
7.80
自引率
2.60%
发文量
33
审稿时长
55 days
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