Swedish Medical Products Agency Reg #: ISI: 2003-57143.
Tacrolimus without or with the addition of conventional immunosuppressive treatment in juvenile autoimmune hepatitis
Article first published online: 19 JUN 2012
© 2012 The Author(s)/Acta Pædiatrica © 2012 Foundation Acta Pædiatrica
Volume 101, Issue 9, pages 993–999, September 2012
How to Cite
Marlaka, J. R., Papadogiannakis, N., Fischler, B., Casswall, T. H., Beijer, E. and Németh, A. (2012), Tacrolimus without or with the addition of conventional immunosuppressive treatment in juvenile autoimmune hepatitis. Acta Paediatrica, 101: 993–999. doi: 10.1111/j.1651-2227.2012.02745.x
- Issue published online: 3 AUG 2012
- Article first published online: 19 JUN 2012
- Accepted manuscript online: 30 MAY 2012 10:17AM EST
- Received 30 November 2011; revised 16 May 2012; accepted 21 May 2012.
- Adverse events;
- Juvenile autoimmune hepatitis;
- Liver transplantation;
Aim: To investigate tacrolimus (Tac)-based treatment in juvenile autoimmune hepatitis (AIH). Twenty patients (13 girls; age, 8–17 years; median, 13.25 years) with AIH were treated with two daily oral doses of Tac. Six of them had advanced liver disease and/or cirrhosis.
Methods: Drug concentrations in blood were measured regularly, and the target trough levels were 2.5–5 ng/mL. The patients were followed up for 1 year. Their clinical, biochemical, immunological and histological status was obtained at baseline and after 1 year.
Results: In three cases, Tac alone led to complete remission. In 14 cases, additional low doses of prednisolone or azathioprine were used for a short time to achieve remission. In two cases, the treatment was discontinued: in one because of therapeutic failure, in another because of a suspected but unverified adverse event. Ten patients reported headache and/or recurrent abdominal pain. Two patients developed inflammatory bowel disease. Renal function remained intact.
Conclusion: Tac is a promising alternative first line of treatment for AIH. Although monotherapy with Tac is usually not sufficient to achieve complete remission, the prednisolone and azathioprine doses can be drastically reduced, and most of their side effects avoided.