Mycophenolate mofetil for maintenance of remission in autoimmune hepatitisin patients resistant to or intolerant of azathioprine

Background/Aim: Azathioprine is standard therapy for maintenance of remissi on in patients with autoimmune hepatitis. However, approximately 15% of pat ients are intolerant of therapy and 10% do not respond to it. There is a ne ed for alternative therapies. We describe here the results of mycophenolate mofetil therapy in patients with autoimmune hepatitis. Patients: We studied seven patients with type I AIH (six female). Three wer e intolerant of azathioprine and had elevated transaminases and liver histo logy showing active disease despite prednisolone therapy. Four had been on a dose of 2 mg per kg of azathioprine without complete normalisation of AET , and had liver biopsies showing active disease. All were treated with myco phenolate 1 g bd and were followed for a median of 46 months (21-59), End p oints were improvement in histological inflammation, ALT and prednisolone d ose. Results: Five of the seven (71%) patients had normal transaminases after 3 months of treatment, The steroid dose fell from a median of 20 mg per day t o 2 mg per day at 9 months (p=0.0001) and the hepatic activity index fell f rom median 11 to 3 (p=0.001) after 7 months of therapy. One patient require d dose reduction because of a fall in white cell count. No other adverse ef fects were seen, Conclusions: Mycophenolate mofetil is effective and well tolerated in patie nts with type 1 AIH who are intolerant of or do not respond to, azathioprin e.