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Tacrolimus and mycophenolate mofetil as second-line treatment in autoimmune hepatitis
Tacrolimus and mycophenolate mofetil as second-line treatment in autoimmune hepatitis
- Source :
- World Journal of Gastroenterology, World Journal of Gastroenterology, 26(38), 5896-5910. Baishideng Publishing Group Inc.
- Publication Year :
- 2020
- Publisher :
- Baishideng Publishing Group Inc., 2020.
-
Abstract
- BACKGROUNDThe standard management of autoimmune hepatitis (AIH) is based on corticosteroids, alone or in combination with azathioprine. Second-line treatments are needed for patients who have refractory disease. However, high-quality data on the alternative management of AIH are scarce.AIMTo evaluate the efficacy and safety of tacrolimus and mycophenolate mofetil (MMF) and the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE).METHODSA systematic review and meta-analysis of the available data were performed. We calculated pooled event rates for three outcome measures: Biochemical remission, adverse events, and mortality, with their corresponding 95% confidence intervals (CI).RESULTSThe pooled biochemical remission rate was 68.9% (95%CI: 60.4-76.2) for tacrolimus, and 59.6% (95%CI: 54.8-64.2) for MMF, and rates of adverse events were 25.5% (95%CI: 12.4-45.3) for tacrolimus and 24.1% (95%CI: 15.4-35.7) for MMF. The pooled mortality rate was estimated at 11.5% (95%CI: 7.1-18.1) for tacrolimus and 9.01% (95%CI: 6.2-12.8) for MMF. Pooled biochemical remission rates for tacrolimus and MMF in patients with intolerance to standard therapy were 56.6% (CI: 43.4-56.6) vs 73.5% (CI: 58.1-84.7), and among non-responders were 59.1% (CI: 48.7-68.8) vs 40.8% (CI: 32.3-50.0), respectively. Moreover, the overall quality assessments using GRADE proved to be very low for all our outcomes in both treatment groups.CONCLUSIONTacrolimus and MMF are in practice considered effective for patients with AIH who are non-responders or intolerant to first-line treatment, but we found no high-quality evidence to support this statement.
- Subjects :
- medicine.medical_specialty
Efficacy
Azathioprine
Autoimmune hepatitis
Second-line
Mycophenolate
DIAGNOSIS
THERAPY
Tacrolimus
Grading of Recommendations Assessment
INTOLERANT
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
MANAGEMENT
Humans
Adverse effect
business.industry
Mortality rate
Gastroenterology
General Medicine
Mycophenolic Acid
medicine.disease
Confidence interval
Hepatitis, Autoimmune
Meta-analysis
Treatment Outcome
GRADE
Grading of Recommendations Assessment, Development and Evaluation approach
030220 oncology & carcinogenesis
Systematic review
UPDATE
030211 gastroenterology & hepatology
business
CONSENSUS
Immunosuppressive Agents
Development and Evaluation approach
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 10079327
- Volume :
- 26
- Issue :
- 38
- Database :
- OpenAIRE
- Journal :
- World Journal of Gastroenterology
- Accession number :
- edsair.doi.dedup.....ea9221c516dc788791517e164306fa3d