P1243 - Efficacy of Mycophenolate Mofetil vs Standard Therapy for the Treatment of Autoimmune Hepatitis: An Updated Meta-Analysis

Award: Presidential Poster Award

Osama Ijaz, MBBS¹, Zoha Shahzad, MBBS², Asad Gul Rao, MBBS³, Badr ilmaguook, MD⁴, Faateh A. Rauf, MBBS⁵, Syed Muhammad Ali Shah, MBBS⁶, Rahila Ali, MD⁷, Khawaja Abdul Rehman, MBBS⁸, Muhammad Talha Bajwa, ^1
1Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; ²Fatima Jinnah Medical University, Lahore, Punjab, Pakistan; ³Dow University of Health Sciences, Karachi, Sindh, Pakistan; ⁴NYC Health + Hospitals/Woodhull, Brooklyn, NY; ⁵Icahn School of Medicine at Mount Sinai, Fresh Meadows, NY; ⁶One Brooklyn Health, Brooklyn, NY; ⁷Memorial Hospital Gulfport, Long Beach, MS; ⁸CMH Lahore Medical College, Lahore, Punjab, Pakistan

Introduction: Autoimmune hepatitis (AIH) is a chronic inflammatory disease of the liver that can range from mild symptoms to fulminant hepatitis. Regarding treatment, it is treated by prednisone plus azathioprine (AZA) as the standard therapy, and mycophenolate mofetil (MMF) is used as a second-line agent. In this meta-analysis, we attempt to draw a comparison between the effectiveness of AZA and MMF in managing the progression of AIH.

Methods: A systemic search of Medline, Embase, Google Scholar, Cochrane CENTRAL, Scopus, and clinicaltrials.gov was conducted from inception to May 2024. We included observational studies and randomized controlled trials (RCTs) comparing AZA plus prednisone and MMF plus prednisone for the treatment of AIH, ensuring they had comparable outcomes. The primary outcome that was assessed included the number of patients with decreased levels of aminotransferases whereas secondary outcomes were the number of patients with decreased levels of IgG and presence of no response. A meta-analysis using a random effects model was performed on the pooled data of each outcome. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated to present the overall effect.

Results: Eight studies involving 880 participants were included in the final analysis. Pooled analyses revealed that MMF plus prednisone significantly increased the number of patients with decreased aminotransferase levels as compared to AZA plus prednisone [OR: 1.73 (1.03 to 2.88); p=0.04; I2=47%]. Similarly, there was an increase in the number of patients with decreased levels of IgG in the MMF arm [OR: 1.75 (1.22 to 2.51); p=0.02; I2=0%] whereas the number of patients with no response to treatment was significantly lower in the MMF arm [OR: 0.50 (0.34 to 0.73); p=0.0003; I2=0%].

Discussion: The findings of this meta-analysis suggest that MMF therapy demonstrates greater efficacy compared to AZA in the treatment of AIH, which aligns with the findings of the previous meta-analysis. Consequently, it provides a rationale for considering MMF plus prednisone as a superior first-line treatment option for AIH over AZA plus prednisone. Further research is required to validate these results and explore the extent to which MMF excels in reducing aminotransferase levels as well as other indicators of disease progression. If subsequent studies demonstrate greater efficacy and safety of MMF regimen compared to AZA, it could potentially establish MMF plus prednisone as the standard treatment for AIH.



Disclosures:


Osama Ijaz, MBBS¹, Zoha Shahzad, MBBS², Asad Gul Rao, MBBS³, Badr ilmaguook, MD⁴, Faateh A. Rauf, MBBS⁵, Syed Muhammad Ali Shah, MBBS⁶, Rahila Ali, MD⁷, Khawaja Abdul Rehman, MBBS⁸, Muhammad Talha Bajwa, ¹. P1243 - Efficacy of Mycophenolate Mofetil vs Standard Therapy for the Treatment of Autoimmune Hepatitis: An Updated Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.