Role of Sirolimus and Rituximab in the Treatment of Autoimmune Hepatitis

Abstract

Autoimmune hepatitis (AIH) is a rare chronic liver disease affecting annually 100,000-200,000 individuals in the United States. The first-line therapy in AIH is azathioprine and corticosteroids. However, adverse events may occur, which can preclude disease remission. In these cases, mycophenolate, mercaptopurine, and tacrolimus can be used. Rituximab is offered in difficult to treat cases. Sirolimus is an alternative regimen. However, little is known about its use in AIH. This is a challenging case of "difficult to treat" AIH managed with sirolimus and rituximab, after multiple unsuccessful trials with other medications.

Keywords: autoimmune hepatitis; autoimmune liver disease; liver; rituximab; sirolimus.

Figure 1.

(A) Medications and doses used before sirolimus introduction in the treatment regimen. (B) Diagram depicting the medication trends and AST levels over time. Left y axis: Daily dose of prednisone, azathioprine, and tacrolimus in milligrams. Right y axis: Daily dose of mycophenolate mofetil in milligrams or AST levels in IU/L. *Represent the exacerbation episodes. AST, aspartate aminotransferase; AZA, azathioprine; MMF, mercaptopurine and mycophenolate mofetil.