Original Articles: Immune-Mediated Diseases, DILI, and Biliary Tract Disease

Efficacy and safety of infliximab in patients with autoimmune hepatitis

Efe, Cumali1; Lytvyak, Ellina2; Eşkazan, Tuğçe3; Liberal, Rodrigo4,5; Androutsakos, Theodoros6; Turan Gökçe, Dilara7; Terziroli Beretta-Piccoli, Benedetta8; Janik, Maciej9; Bernsmeier, Christine10,11; Arvaniti, Pinelopi12; Milkiewicz, Piotr9,13; Batibay, Ersin1; Yüksekyayla, Osman1; Ergenç, Ilkay14; Arikan, Çiğdem15; Stättermayer, Albert F.16; Barutçu, Sezgin17; Cengiz, Mustafa18; Gül, Özlem19; Heurgue, Alexandra20; Heneghan, Michael A.14; Verma, Sumita21; Purnak, Tuğrul22; Törüner, Murat23; Akdogan Kayhan, Meral24; Hatemi, Ibrahim3; Zachou, Kalliopi12; Macedo, Guilherme4,5; Drenth, Joost P. H.25; Björnsson, Einar26,27; Montano-Loza, Aldo J.2; Wahlin, Staffan28; Higuera-de la Tijera, Fatima29

Author Information

1Department of Gastroenterology, Harran University Hospital, Şanliurfa, Turkey

2Division of Gastroenterology, University of Alberta, Liver Unit, Edmonton, Alberta, Canada

3Department of Gastroenterology, Cerrahpaşa School of Medicine, İstanbul, Turkey

4Gastroenterology and Hepatology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal

5World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal

6Department of Pathophysiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece

7Department of Gastroenterology, Sincan state Hospital, Ankara, Turkey

8Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Epatocentro Ticino, Lugano, Switzerland. Collaborative Partner European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany

9Department of Hepatology, Transplantology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland. Full member European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany

10Department of Biomedicine, University of Basel, Basel, Switzerland

11University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland

12Department of Medicine and Research Laboratory of Internal Medicine, Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; Full member European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany

13Translational Medicine Group, Pomeranian Medical University in Szczecin, Poland

14Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK; Collaborative Partner European Reference Network on Hepatological Diseases (ERN RARE-LIVER)

15Department of Pediatric Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey

16Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria; Rare Liver Disease (RALID), Affiliated Partner European Reference Network for Rare Hepatological Diseases (ERN RARE-LIVER)

17Department of Gastroenterology, University of Gaziantep Medical Faculty, Gaziantep, Turkey

18Department of Gastroenterology Gülhane Training and Research Hospital Ankara, Turkey

19Department of Gastroenterology, Lokman Hekim Üniversitesi Ankara Hastanesi, Ankara, Turkey

20Department of Hepato-Gastroenterology, CHU Reims, Reims, France

21Brighton and Sussex Medical School, University Hospitals Sussex NHS Foundation Trust, Brighton, UK

22Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, Houston, Texas, USA

23Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey

24Department of Gastroenterology, Ankara City Hospital, Ankara, Turkiye

25Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, The Netherlands; Collaborative Partner European Reference Network RARE-LIVER, Hamburg, Germany

26Faculty of Medicine, University of Iceland, Reykjavik

27Department of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland

28Department of Upper GI Diseases, Hepatology Division, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. Full member European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany

29Gastroenterology and Hepatology Unit, Hospital General de México, Ciudad de México, México

Staffan Wahlin, Aldo J. Montano-Loza, and Fatima Higuera-de la Tijera share senior authorship.

Abbreviations: AIH, autoimmune hepatitis; CR, complete biochemical response; LSM, liver stiffness measurement; MMF, mycophenolate mofetil; ULN, upper limit of normal.

Correspondence Cumali Efe, Department of Gastroenterology, Harran University Hospital, Osmanbey Yerleşkesi, Şanlıurfa-Mardin Karayolu Üzeri 18.Km, 63290 Haliliye/Şanlıurfa, Türkiye. Email: [email protected]

Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal's website, www.hepjournal.com.

Hepatology 81(6):p 1660-1670, June 2025. | DOI: 10.1097/HEP.0000000000001089
  • Buy
  • SDC
  • Infographic

Abstract

Background and Aims: 

A limited number of drugs are used as standard or alternative therapies in autoimmune hepatitis (AIH). No specific recommendations are available for patients failing to respond to these therapies. We analyzed the efficacy and safety of infliximab in patients with AIH.

Approach and Results: 

We performed a retrospective study of 42 patients with AIH who received infliximab at 21 liver centers in 12 countries. Patients were categorized according to the reason for infliximab therapy. Patients in group 1 (n=20) had failed standard, second-line (mycophenolate mofetil and 6-mercaptopurine) or third-line (tacrolimus or cyclosporine) therapy. In group 2 (n=22), infliximab was given for treatment of concomitant extrahepatic autoimmune diseases. Patients received a median of 17 (range: 3–104) infliximab infusions. Complete biochemical response (CR) was achieved or maintained in 33 (78%) patients during infliximab therapy. In group 1, infliximab induced CR in 11 of 20 (55%) patients. In group 2, 16 patients with CR prior to infliximab maintained remission, and the remaining 6 patients with active AIH (5 on standard and 1 on both second-line and third-line therapy) showed CR following infliximab therapy. Infliximab led to CR in 75% (6/8) of nonresponders to second-line and in 46% (6/13) of failing third-line therapy. Overall, 65% (17/26) of the patients with active AIH achieved CR on infliximab. Infliximab was discontinued in 3 patients of group 1. One patient had a severe allergic reaction and 2 developed anti-infliximab autoantibodies.

Conclusions: 

Our study suggests that infliximab may be an effective and safe rescue therapy in AIH.

Abstract
Export

Copyright © 2024 American Association for the Study of Liver Diseases.

Full Text Access for Subscribers:

AASLD members log in here
AASLD members log in here
AASLD members log in here

Not a Subscriber?

Buy
Request Permissions
Become a Society Member

You can read the full text of this article if you:

Access through Ovid