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

• DOI: 10.1111/apt.15248
• Publication Date: 2019-04-12T01:05:54Z
• Authors: 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. McCau...
• Keywords: Adult; Male; Salvage Therapy; 0301 basic medicine; Age Factors; 610; Middle Aged; Mycophenolic Acid; 3. Good health; Hepatitis, Autoimmune; 03 medical and health sciences; Treatment Outcome; Adrenal Cortex Hormones; Immunoglobulin G; Humans; Female; International Normalized Ratio; Retrospective Studies

SummaryBackgroundMycophenolate 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 <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.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.