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Updated: Jan 27, 2026

Induction of Drug-Induced, Autoimmune Hepatitis in BALB/c Mice for the Study of Its Pathogenic Mechanisms
Published on: May 29, 2020
6-Mercaptopurine vs Mycophenolate Mofetil in Autoimmune Hepatitis and Azathioprine Intolerance: A Multicenter Study
Ludwig Jesse Horst1, Alexander Fierenz2, Bernardo Canhão3
1I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.
For autoimmune hepatitis (AIH) patients intolerant to azathioprine (AZA), both 6-mercaptopurine (6-MP) and mycophenolate mofetil (MMF) maintained biochemical response. MMF showed better tolerability, but 6-MP is a viable option, especially for women of reproductive age.
Area of Science:
- Hepatology
- Immunology
- Pharmacology
Background:
- Autoimmune hepatitis (AIH) standard therapy involves azathioprine (AZA) and corticosteroids.
- A significant number of patients discontinue AZA due to intolerance.
- 6-mercaptopurine (6-MP) and mycophenolate mofetil (MMF) are proposed alternatives, but comparative data is limited.
Purpose of the Study:
- To compare the efficacy and safety of 6-MP and MMF as second-line therapies in AIH patients intolerant to AZA.
- To evaluate biochemical response and adverse effects of 6-MP versus MMF.
Main Methods:
- Multicenter retrospective cohort study of 211 AIH patients intolerant to AZA.
- Patients switched to either 6-MP or MMF as second-line treatment.
- Propensity score matching used to validate biochemical response analysis.
Main Results:
- Mycophenolate mofetil (MMF) was better tolerated than 6-mercaptopurine (6-MP) (89% vs. 67%).
- No statistically significant difference in complete biochemical response rates between 6-MP and MMF (61% vs. 66%) among patients continuing treatment.
- Median follow-up was 60 months in 211 AIH patients.
Conclusions:
- Both 6-MP and MMF effectively maintain biochemical response in AZA-intolerant AIH patients.
- MMF demonstrated superior tolerability.
- 6-MP is a safe and effective alternative, particularly for women of reproductive age, allowing for metabolite monitoring and dosage titration.
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