Beneficial response to mycophenolate mofetil by patients with autoimmune hepatitis who have failed standard therapy, is predicted by older age and lower immunoglobulin G and INR levels

Amanda J. Nicoll, Stuart K. Roberts, Ricky Lim, Joanne Mitchell, Martin Weltman, Jacob George, Alan Wigg, Katherine Stuart, Paul Gow, Gerry MacQuillan, Edmund Tse, Miriam Levy, Siddharth Sood, Amany Zekry, Wendy Cheng, Jonathan Mitchell, Richard Skoien, William Sievert, Simone I. Strasser, Geoffrey W. McCaughanon behalf of the ALA Clinical Research Network, Gastroenterological Society of Australia

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15 Citations (Scopus)


Background: 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.

Original languageEnglish
Pages (from-to)1314-1322
Number of pages9
JournalAlimentary Pharmacology & Therapeutics
Issue number10
Publication statusPublished - 1 May 2019

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