Efficacy and Safety of Mycophenolate Mofetil Compared to Azathioprine in Autoimmune Hepatitis: A Meta-Analysis
Bibliographic record
Abstract
Background: Mycophenolate mofetil (MMF) has been suggested as a potential alternative treatment option for patients who are intolerant or unresponsive to the standard corticosteroid and azathioprine (AZA) regimen for autoimmune hepatitis (AIH). This systematic review and meta-analysis aimed to comprehensively evaluate and compare the biochemical efficacy and safety profiles of MMF and AZA in the treatment of AIH. Methods: This review systematically examined the available literature from the inception of the MEDLINE and EMBASE databases up to November 2024. The primary outcomes of interest included the evaluation of biochemical remission (BR), the effectiveness of MMF in patients who were non-responsive (AZA-NR) or intolerant to azathioprine (AZA-IT), and the assessment of adverse events (AEs) and overall survival. Results: This meta-analysis evaluated 11 studies comprising 952 participants, with 57.45% receiving MMF and the remaining receiving AZA. The findings indicate that MMF demonstrated a significantly higher BR rate (88.57%) than AZA (53.64%). The pooled analysis revealed a substantial improvement in the BR rate with MMF compared to AZA (odds ratio (OR): 7.81, 95% confidence interval (CI): 2.21 - 27.69). Furthermore, the estimated enhancement in treatment efficacy with MMF was 61% (95% CI: 42.63 - 78.04) among AZA-NR patients and 61.73% (95% CI: 54.88 - 68.35) in AZA-IT patients. However, the analysis did not reveal any significant differences between the two groups in terms of AEs (OR: 0.57, P = 0.47) and overall survival (OR: 1.27, P = 0.64). Conclusions: MMF may be a suitable first-line alternative to AZA for AIH, with higher rates of BR, especially in patients intolerant or non-responsive to standard therapy. However, the long-term efficacy and safety of MMF requires further investigation through rigorous randomized controlled trials.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.023 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.055 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".