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 000, Number 000, June 2025, pages 000-000

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

Figures

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

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