Successful treatment of refractory type 1 autoimmune hepatitis with methotrexate

doi:10.1016/S0168-8278(98)80128-1

Journal of Hepatology

Volume 29, Issue 6, December 1998, Pages 990-993

https://doi.org/10.1016/S0168-8278(98)80128-1 Get rights and content

Abstract

Background/Aims: Autoimmune hepatitis is a heterogeneous disorder that typically responds to glucocorticoids with or without azathioprine. Treatment options for patients not responding to standard therapy are limited.

Methods: We describe a 52-year-old female who presented with jaundice, marked elevation in liver enzymes, positive antinuclear antibody and a liver biopsy consistent with autoimmune hepatitis. Liver enzymes did not normalize with prednisone alone. When azathioprine was added, the disease flared. The patient refused cyclosporine. Methotrexate 7.5 mg po per week resulted in normalization of liver enzymes, improved liver histology, and has maintained remission with a steroid-sparing effect.

Results/Conclusion: In this patient methotrexate was used successfully to treat type 1 autoimmune hepatitis. This suggests that methotrexate may have a role in treatment of autoimmune hepatitis refractory to standard therapy.

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Azathioprine monotherapy has been demonstrated to maintain remission in most patients with AIH, although only in retrospective adult series, and its long-term use is potentially burdened by the risk of developing malignancies. All of these are compelling reasons to refine current treatment strategies and pursue new management options [20–23]. Cyclosporine was initially used to prevent allograft rejection after solid organ transplantation.
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Successful treatment of refractory type 1 autoimmune hepatitis with methotrexate

Abstract

J Hepatol

Gastroenterology

Gastroenterology

Gastroenterology

Autoimmune hepatitis

N Engl J Med

Chronic active hepatitis associated with anti-liver/kidney microsome antibody type 1: a second type of “auto-immune” hepatitis

Hepatology

Prognostic features and role of liver transplantation in severe corticosteroid-treated chronic active hepatitis.

Hepatology

Treatment of autoimmune hepatitis

Gut

Azathioprine for long-term maintenance of remission in autoimmune hepatitis.

N Engl J Med

Meeting Report: International Autoimmune Hepatitis Group.

Hepatology