Management of Nonresponders to First-line Drugs in Autoimmune Hepatitis

Management of Nonresponders to First-line Drugs in Autoimmune Hepatitis

• Mycophenolate mofetil (MMF): It is an alternative for patients who are intolerant to azathioprine with a response rate of 58% to 61%. This works by inhibiting purine biosynthesis and exhibiting an antiproliferative effect on T- and B-cells.
• Tacrolimus: This calcineurin inhibitor might be much better than MMF for nonresponder. The response rate of this drug is 59%. This works by suppressing IL-2 synthesis, thereby decreasing T-cell proliferation and differentiation. In severe cases or when conventional immunosuppressive therapy fails, biological agents such as rituximab (anti-CD20 monoclonal antibody) can be used. These agents target B-cells to help control the autoimmune response. Studies have shown that rituximab improves AIH activity by significantly decreasing OT/PT, and serum IgG at 1 month and increasing serum albumin levels. These studies have shown that rituximab is:
• Safe and effective
• Validates the utility of B-cells depletion therapy in refractory AIH
• PRCTs for licensing indications.