Methotrexate as Second-Line Therapy for Autoimmune Hepatitis

First-line treatment of autoimmune hepatitis (AIH) includes steroids and azathioprine. Second-line agents include mycophenolate mofetil and calcineurin inhibitors, such as tacrolimus and cyclosporine. Although some guidelines also recommend methotrexate as a potential second-line agent, this recommendation is based on only a few case reports.

The current case series included 11 adult patients identified from a tertiary referral center in Melbourne, Australia. All patients had a diagnosis of definite AIH based on standard criteria and were receiving methotrexate weekly with folic acid supplement.

Nine of the 11 patients had not achieved biochemical response prior to starting methotrexate. The median dose of methotrexate was 10 mg weekly. Six o…