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

被引：25

作者：

Nicoll, Amanda J. ^{[12
,13
]}

Roberts, Stuart K. ^{[10
,13
]}

Lim, Ricky

Mitchell, Joanne ^{[10
]}

Weltman, Martin ^{[20
]}

George, Jacob ^{[2
,3
]}

Wigg, Alan ^{[21
]}

Stuart, Katherine ^{[18
]}

Gow, Paul ^{[4
]}

MacQuillan, Gerry ^{[6
,7
]}

Tse, Edmund ^{[19
]}

Levy, Miriam ^{[5
]}

Sood, Siddharth ^{[16
]}

Zekry, Amany ^{[22
,23
]}

Cheng, Wendy ^{[1
]}

Mitchell, Jonathan ^{[11
]}

Skoien, Richard ^{[15
]}

Sievert, William ^{[13
,14
]}

Strasser, Simone I. ^{[8
,17
]}

McCaughan, Geoffrey W. ^{[8
,9
]}

Cheng, Wendy ^{[1
]}

George, Jacob ^{[2
,3
]}

Gow, Paul ^{[4
]}

Levy, Miriam ^{[5
]}

McCaughan, Geoffrey W. ^{[8
,9
]}

Mitchell, Joanne ^{[10
]}

Mitchell, Jonathan ^{[11
]}

Nicoll, Amanda J. ^{[12
,13
]}

Roberts, Stuart K. ^{[10
,13
]}

Sievert, William ^{[13
,14
]}

Skoien, Richard ^{[15
]}

Sood, Siddharth ^{[16
]}

Strasser, Simone I. ^{[8
,17
]}

Stuart, Katherine ^{[18
]}

Tse, Edmund ^{[19
]}

Weltman, Martin ^{[20
]}

Wigg, Alan ^{[21
]}

Zekry, Amany ^{[22
,23
]}

机构：

[1] Royal Perth Hosp, Dept Gastroenterol, Perth, WA, Australia

[2] Westmead Hosp, Storr Liver Ctr, Sydney, NSW, Australia

[3] Westmead Inst Med Res, Sydney, NSW, Australia

[4] Austin Hlth, Dept Gastroenterol, Melbourne, Vic, Australia

[5] Liverpool Hosp, Dept Gastroenterol, Sydney, NSW, Australia

[6] Univ Western Australia, Sir Charles Gairdner Hosp, Dept Hepatol, Nedlands, WA, Australia

[7] Univ Western Australia, Sch Med, Fac Med & Hlth Sci, Nedlands, WA, Australia

[8] Royal Prince Alfred, AW Morrow Gastroenterol & Liver Ctr, Sydney, NSW, Australia

[9] Centenary Inst, Sydney, NSW, Australia

[10] The Alfred, Dept Gastroenterol, Melbourne, Vic, Australia

[11] Nambour Gen Hosp, Dept Gastroenterol, Nambour, Qld, Australia

[12] Eastern Hlth, Dept Gastroenterol, Melbourne, Vic, Australia

[13] Monash Univ, Melbourne, Vic, Australia

[14] Monash Hlth, Dept Gastroenterol, Melbourne, Vic, Australia

[15] Royal Brisbane Hosp, Dept Gastroenterol, Brisbane, Qld, Australia

[16] Royal Melbourne Hosp, Dept Gastroenterol & Hepatol, Melbourne, Vic, Australia

[17] Univ Sydney, Sydney, NSW, Australia

[18] Princess Alexandra Hosp, Dept Gastroenterol, Brisbane, Qld, Australia

[19] Royal Adelaide Hosp, Dept Gastroenterol, Adelaide, SA, Australia

[20] Nepean Hosp, Dept Gastroenterol, Kingswood, NSW, Australia

[21] Flinders Med Ctr, Dept Gastroenterol & Hepatol, Adelaide, SA, Australia

[22] St George Hosp, Dept Gastroenterol, Sydney, NSW, Australia

[23] Univ New South Wales, Dept Med, Sydney, NSW, Australia

来源：

ALIMENTARY PHARMACOLOGY & THERAPEUTICS | 2019年 / 49卷 / 10期

关键词：

CORTICOSTEROID-THERAPY; BIOCHEMICAL REMISSION; NATURAL-HISTORY; REAL-WORLD; MANAGEMENT; DIAGNOSIS; CIRRHOSIS; CRITERIA; PATHOGENESIS; POPULATION;

D O I：

10.1111/apt.15248

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BackgroundMycophenolate mofetil is a commonly used salvage therapy for patients with autoimmune hepatitis (AIH). AimTo evaluate the predictors of response to mycophenolate rescue therapy to facilitate clinical decision making. MethodsWe 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. ResultsA 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 <17g/L had a positive and negative predictive value for response of 71% and 60% respectively, while age 54years when commencing mycophenolate had a positive and negative predictive value for response of 80% and 59% respectively. ConclusionMycophenolate 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.

引用

页码：1314 / 1322

页数：9