TY - JOUR
T1 - Calcineurin Inhibitors in the Treatment of Adult Autoimmune Hepatitis
T2 - A Systematic Review
AU - Baven-Pronk, Martine A. M. C.
AU - Hew, Joffre M.
AU - Biewenga, Maaike
AU - Tushuizen, Maarten E.
AU - van den Berg, Aad P.
AU - Bouma, Gerd
AU - Brouwer, Johannes T.
AU - van Hoek, Bart
N1 - Publisher Copyright: © 2022 The Author(s).
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background and Aims: A considerable number of autoimmune hepatitis (AIH) patients completely or partially fail on first-line treatment. Several studies on the use of calcineurin inhibitors (CNIs) in the treatment of AIH have been published without focusing on indication. The aim was to assess the efficacy of CNIs in the treatment of adult AIH patients, specifically focusing on indication: first-line intolerant and with first-line insufficient response (failure to achieve or maintain remission), and with second versus third-line treatment. Methods: A literature search included studies on the use of CNIs in adult AIH. Patients with past or present use of CNIs from the Dutch AIH group cohort were added. The primary endpoint was biochemical remission while using CNIs. Secondary endpoints were biochemical response, treatment failure, and adverse effects. Results: Twenty studies from the literature and nine Dutch patients were included describing the use of cyclosporine in 59 and tacrolimus in 219 adult AIH patients. The CNI remission rate was 53% in patients with insufficient response to first-line treatment and 67% in patients intolerant to first-line treatment. CNIs were used as second-line treatment in 73% with a remission rate of 52% and as third-line treatment in 22% with a remission rate of 26%. Cyclosporine was discontinued in 13% and tacrolimus in 11% of patients because of adverse events. Conclusions: CNIs as rescue treatment in adult AIH patients are reasonably effective and safe both with insufficient response or intolerance to previous treatment. Prospective studies are needed.
AB - Background and Aims: A considerable number of autoimmune hepatitis (AIH) patients completely or partially fail on first-line treatment. Several studies on the use of calcineurin inhibitors (CNIs) in the treatment of AIH have been published without focusing on indication. The aim was to assess the efficacy of CNIs in the treatment of adult AIH patients, specifically focusing on indication: first-line intolerant and with first-line insufficient response (failure to achieve or maintain remission), and with second versus third-line treatment. Methods: A literature search included studies on the use of CNIs in adult AIH. Patients with past or present use of CNIs from the Dutch AIH group cohort were added. The primary endpoint was biochemical remission while using CNIs. Secondary endpoints were biochemical response, treatment failure, and adverse effects. Results: Twenty studies from the literature and nine Dutch patients were included describing the use of cyclosporine in 59 and tacrolimus in 219 adult AIH patients. The CNI remission rate was 53% in patients with insufficient response to first-line treatment and 67% in patients intolerant to first-line treatment. CNIs were used as second-line treatment in 73% with a remission rate of 52% and as third-line treatment in 22% with a remission rate of 26%. Cyclosporine was discontinued in 13% and tacrolimus in 11% of patients because of adverse events. Conclusions: CNIs as rescue treatment in adult AIH patients are reasonably effective and safe both with insufficient response or intolerance to previous treatment. Prospective studies are needed.
KW - Autoimmune hepatitis
KW - Calcineurin inhibitor
KW - Cyclosporine
KW - Tacrolimus
UR - http://www.scopus.com/inward/record.url?scp=85140028723&partnerID=8YFLogxK
U2 - https://doi.org/10.14218/JCTH.2021.00535
DO - https://doi.org/10.14218/JCTH.2021.00535
M3 - Article
C2 - 36381101
SN - 2225-0719
VL - 10
SP - 1155
EP - 1166
JO - Journal of clinical and translational hepatology
JF - Journal of clinical and translational hepatology
IS - 6
ER -