Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website https://gr.elmerpub.com

Original Article

Volume 18, Number 4, August 2025, pages 164-174

Efficacy and Safety of Mycophenolate Mofetil Compared to Azathioprine in Autoimmune Hepatitis: A Meta-Analysis

Figures

↓  Figure 1. Forest plot of comparison of mycophenolate mofetil (MMF) with azathioprine (AZA) for biochemical remission.
Figure 1.
↓  Figure 2. Forest plot of comparison of mycophenolate mofetil (MMF) with azathioprine (AZA) for biochemical remission at 6 months.
Figure 2.
↓  Figure 3. Forest plot of pooled biochemical remission of mycophenolate mofetil (MMF) in azathioprine non-respondents (AZA-NR).
Figure 3.
↓  Figure 4. Forest plot of pooled biochemical remission of mycophenolate mofetil (MMF) in azathioprine intolerants (AZA-IT).
Figure 4.
↓  Figure 5. Forest plot of comparison of mycophenolate mofetil (MMF) with azathioprine (AZA) for adverse events.
Figure 5.

Tables

↓  Table 1. Characteristics of Included Studies
 
StudyDesignCountryYear of studyStudy groupsDefinition of autoimmune hepatitisFollow-up duration (months)Patients received MMFPatients received AZACirrhosis, N (%)Age (mean), treatment/controlSex (female)
AZA: azathioprine; AZA-IT: azathioprine intolerant; AZA-NR: azathioprine non-respondent; IAHG: International Autoimmune Hepatitis Group; MMF: mycophenolate mofetil.
Hlivko et al [13]RetrospectiveUSA2008AZA vs. MMFAASLD criteria13179222%42.8 ± 16.982.8%
Giannkapoulos et al [14]Retrospective multicenterSweden2018AZA vs. MMFAASLD criteria0-242222646.5/50.554.5%
Baven-Pronk et al [15]Retrospective multicentricNetherlands/Belgium2011AZA-IT/AZA-NRIAHG criteria39151511 (37.7)38/3586.7%
Sharzehi et al [16]RetrospectiveUSA2010AZA-IT/AZA-NRClinical/serologic/biochemical/histologic42212046.3/55.775%
Roberts et al [17]RetrospectiveAustralia2018AZA-IT/AZA-NRIAIHG341059438 (37)50/5283.3%
Liberal et al [18]RetrospectivePortugal2021AZA-IT/AZA-NRIAIHG781818444.5/33.383%
Kolev et al [19]RetrospectiveSwitzerland2022AZA-IT/AZA-NRIAIHG51.550504 (8)49.5/5182.5%
Hennes et al [20]Retrospective multicenterGermany and UK2008AZA-IT/AZA-NRIAIHG242727-46/4275%
Dalekos et al [21]Prospective cohortGreece2021AZA vs. MMFIAIHG393232MMF: 6
AZA: 6		54/5571.8%
Dalekos et al [22]Prospective cohortGreece2022AZA vs. MMFIAIHG3918364MMF: 38 (20.7)
AZA: 12 (18.8)		49/4873.2% (MMF)
73.4% (AZA)
Snijders et al (CAMARO trial) [23]RCTNetherland/Belgium2024AZA vs. MMFIAIHG63931MMF: 10 (26)
AZA: 7 (23)		60 ± 14
56 ± 14.4		76.9% (MMF)
70% (AZA)

 

↓  Table 2. Adverse Events
 
Adverse eventsAZA (n = 272), n (%)MMF (n = 381), n (%)
AZA: azathioprine; MMF: mycophenolate mofetil.
Gastrointestinal symptoms37 (13.6)45 (11.8)
Skin abnormalities4 (1.5)10 (2.6)
Hair loss6 (1.5)4 (1)
Myalgias4 (1.4)5 (1.3)
Myelotoxicity6 (2.2)1 (0.3)
Hepatotoxicity5 (1.8)0
Infections10 (3.7)13 (3.4)
Malignancy02 (0.5)
Pancreatitis1 (0.3)0