P2891 - Mycophenolate Mofetil Versus Azathiopurine in Autoimmune Hepatitis: A Systematic Review and Meta-Analysis

Nouman Shafique, MD¹, Fnu Muhibullah, MD, MBBS², Abdul Qadeer, ³, Nihal I. Khan, MD¹, Syed Hamaad Rahman, DO⁴, Adeena Shafique, ⁵, Ammar Hasan, MD⁶, Iqra Shafiq, MBBS⁷, Muhammad Raheel Awan, MD⁸, Salman Ayub Jajja, MD³, Ali Haider, MD⁹, Zaigham ul Islam, MBBS¹⁰, Saleha Maryam, MD³, Abu Hurairah, MD^1
1AdventHealth Medical Group, AdventHealth, Orlando, FL; ²West Virginia University Camden Clark Medical Center, Parkersburg, WV; ³Nishtar Medical University, Multan, Punjab, Pakistan; ⁴Methodist Dallas Medical Center, Irving, TX; ⁵Aga Khan University, Karachi, Sindh, Pakistan; ⁶HCA Kingwood, Kingwood, TX; ⁷Combined Military Hospital, Bahawalpur, Punjab, Pakistan; ⁸Carle Foundation Hospital, Champaign, IL; ⁹Nishtar Medical University, Chicago, IL; ¹⁰Nishtar Medical University, Rajanpur, Punjab, Pakistan

Introduction: Autoimmune hepatitis (AIH) is an inflammatory disease that may start as acute hepatitis and result in chronic liver disease marked by a spectrum of presentations. Immunosuppressant such as glucocorticoids and azathioprine (AZT) have been considered a standard treatment modality, but the treatments usually need to be lifelong as relapses are common. Evidence is emerging in favor of alternative immunosuppressant such as mycophenolate mofetil (MMF), but a consensus has yet to be reached. In this systematic review and meta-analysis, we aim to explore the comparison between MMF and AZT in AIH.

Methods: We searched various databases from their inception until June 2024. We included studies with a direct comparison of MMF with AZT in a patient population with AIH. The primary outcome was a complete biochemical remission (CBR) at 6 months. Secondary outcomes were treatment discontinuation due to any cause, and non-response rate. The comparison was done using comparing the odds ratio of events in each drug category. A random effect meta-analysis was done by R software to pool effect sizes.

Results: A total of nine full-text studies were included that fulfilled the inclusion criteria. Seven of them were retrospective cohorts, and two of them were prospective studies done in a patient population with AIH. The total population was 1006, and the follow-up period ranged from 17 months to 57 months. In our meta-analysis, MMF was found to be superior as compared to AZT in achieving CBR at 6 months, but the association was not significant, odds ratio (odds ratio) of AZT versus MMF was 0.45, with a confidence interval (CI) of 0.21-1.01, p = 0.14, and I2 = 50%. Treatment discontinuation due to any side effect was much more common in AZT, with an OR of 8.07, CI = 5.19-12.55, p = 0.47, and I2 = 0%. MMF was better at preventing no response, but this association was not significant, OR of no response events in the AZT group was 1.82, CI = 0.84-3.91, p = 0.24, and I2 = 30%.

Discussion: MMF seems to be a better choice in AIH as compared to AZT, as it has significantly lower events leading to discontinuation. CBR at 6 months and treatment discontinuation rates also appear to be better, although the association was not significant. Until now, AZT has been the first-line treatment but as more and more evidence emerges, MMF can be considered a first-line option. More studies with a longer follow-up duration are needed to find more conclusive evidence that can change treatment guidelines for AIH.



Disclosures:


Nouman Shafique, MD¹, Fnu Muhibullah, MD, MBBS², Abdul Qadeer, ³, Nihal I. Khan, MD¹, Syed Hamaad Rahman, DO⁴, Adeena Shafique, ⁵, Ammar Hasan, MD⁶, Iqra Shafiq, MBBS⁷, Muhammad Raheel Awan, MD⁸, Salman Ayub Jajja, MD³, Ali Haider, MD⁹, Zaigham ul Islam, MBBS¹⁰, Saleha Maryam, MD³, Abu Hurairah, MD¹. P2891 - Mycophenolate Mofetil Versus Azathiopurine in Autoimmune Hepatitis: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.