Z Gastroenterol 2025; 63(01): e30
DOI: 10.1055/s-0044-1801079
Abstracts │ GASL
Poster Visit Session II
CLINICAL HEPATOLOGY, SURGERY, LTX 14/02/2025, 02.20pm – 03.15pm

Evaluation of tacrolimus and mycophenolate mofetil as second-line therapy in autoimmune hepatitis – real-world data from the Charité Berlin cohort

Clara vom Endt
1   Department of Gastroenterology and Hepatology, Charité – Berlin University Medicine, Berlin, Germany
,
Martin Kluge
1   Department of Gastroenterology and Hepatology, Charité – Berlin University Medicine, Berlin, Germany
,
Florian Roßner
2   Department of Pathology, Charité – Berlin University Medicine, Berlin, Germany
,
Josephine Frohme
1   Department of Gastroenterology and Hepatology, Charité – Berlin University Medicine, Berlin, Germany
,
Julian Pohl
1   Department of Gastroenterology and Hepatology, Charité – Berlin University Medicine, Berlin, Germany
,
Leke Wiering
1   Department of Gastroenterology and Hepatology, Charité – Berlin University Medicine, Berlin, Germany
,
Lena Maria Greverath
1   Department of Gastroenterology and Hepatology, Charité – Berlin University Medicine, Berlin, Germany
,
Tobias Puengel
1   Department of Gastroenterology and Hepatology, Charité – Berlin University Medicine, Berlin, Germany
,
Münevver Demir
1   Department of Gastroenterology and Hepatology, Charité – Berlin University Medicine, Berlin, Germany
,
Frank Tacke
1   Department of Gastroenterology and Hepatology, Charité – Berlin University Medicine, Berlin, Germany
,
Alena Laschtowitz
1   Department of Gastroenterology and Hepatology, Charité – Berlin University Medicine, Berlin, Germany
,
Moritz Peiseler
1   Department of Gastroenterology and Hepatology, Charité – Berlin University Medicine, Berlin, Germany
› Author Affiliations
 

Introduction: Azathioprine with steroids is considered the standard first-line treatment for autoimmune hepatitis (AIH). The CAMARO study suggests mycophenolate mofetil (MMF) with steroids being equally effective in treatment-naive AIH. The optimal second line therapy for AIH, e.g. efficacy and tolerability of tacrolimus, is less well defined.

Methods: We performed a retrospective single-centre study on second-line therapies for AIH. Criteria for exclusion were additional autoimmune liver diseases or liver transplantation. Biochemical parameters were collected at change of therapy, after 12 months and at last follow-up. Biochemical remission was defined as normalization of transaminases and immunoglobulin G.

Results: At Charité Berlin, 59 out of 490 AIH patients received MMF or tacrolimus as second-line therapy. Of 59 patients, 12 received tacrolimus (50% with cirrhosis) and 47 received MMF (19.1% with cirrhosis) (cirrhosis: p=0.036). Both groups showed significant ALT reductions after 12 months. Despite significantly higher levels of alanine aminotransferase (ALT) at change of therapy in the tacrolimus group (ALT/ULN 4.1 vs. 1.6 in the MMF group, p=0.031), biochemical remission was achieved in more patients on tacrolimus compared to MMF (66.6% vs. 50%, p=0.187). The median duration of second-line therapy was significantly longer with MMF (46 months) than with tacrolimus (25 months) (p=0.007). Drug discontinuation due to side effects occurred in 2 tacrolimus patients and 5 MMF patients.

Conclusion: Our results indicate that both MMF and tacrolimus are effective second-line therapies for AIH, with tacrolimus showing numerically higher remission rates and being used more frequently in patients with advanced and more active liver disease.



Publication History

Article published online:
20 January 2025

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