Front Immunol: Preliminary results of a propensity-matched trial of mycophenolate mofetil versus azathioprine in treatment-naïve AIH patients

Autoimmune hepatitis (AIH) is a disease of unknown etiology characterized by markedly elevated serum immunoglobulin G (IgG) levels, non-organ and/or organ-specific immunoglobulin G (IgG) and Autoimmune hepatitis, borderline hepatitis histologically, and immunosuppressive therapy responded well
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The use of corticosteroids with or without azathioprine (AZA) is considered standard of care for first-line treatment

Immunoprophylaxis _

AZA is metabolized to 6-mercaptopurine (6-MP), followed by 6-thioguanine (6-TGN) and 6-thiouric acid or 6-methylmercaptopurine
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It induces non-selective immunosuppression mainly through the inhibition of purine synthesis by 6TGN

On the other hand, mycophenolate mofetil (MMF), a prodrug of mycophenolic acid, is activated after deesterification by the liver
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Mycophenolic acid is the first potent, selective, reversible and noncompetitive inhibitor of inosine-5'-monophosphate dehydrogenase type II isoform, resulting in activated B and T lymphocytes specificity guanosine-triphosphate depletion

As previous real-world studies and meta-analyses suggest that mycophenolate mofetil (MMF) may have better efficacy than azathioprine (AZA) in the treatment of autoimmune hepatitis (AIH), we conducted a propensity-matched study to evaluate MMF and the efficacy and safety of AZA
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A total of 126 consecutively treated adult AIH patients diagnosed and followed up in our department since 2016 were included
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Prednisolone 0.

After propensity-matched scores and adjustment for known factors affecting treatment response and outcome, 64 patients were included in the study (MMF=32, AZA=32)
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Rates of non-response, complete biochemical response (CBR) at 6 and 12 months, and prednisolone discontinuation (6 months, 12 months, and end of follow-up) were the same in both groups

We show for the first time in a propensity-matched study that MMF can be used as a first-line treatment for AIH with significantly higher CBR at the end of follow-up than AZA, which demonstrates that MMF can be used as a first-line treatment for AIH
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Whether this better efficacy is also associated with higher histologic remission rates and sustained CBR detachment from immunosuppression requires further evaluation

Source: Dalekos GN, Arvaniti P, Gatselis NK, et al.

Dalekos GN, Arvaniti P, Gatselis NK, et al.
First Results From a Propensity Matching Trial of Mycophenolate Mofetil vs.
Azathioprine in Treatment-Naive AIH Patients.
Front Immunol 2021;12 Leave a Comment