{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:41:49Z","timestamp":1785253309724,"version":"3.55.0"},"reference-count":50,"publisher":"Wiley","issue":"3-4","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":79,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Digest Diseases"],"published-print":{"date-parts":[[2025,3]]},"abstract":"ABSTRACT<\/jats:title>Objectives<\/jats:title>Autoimmune Hepatitis (AIH<\/jats:styled-content>) is a chronic inflammatory liver disease with significant morbidity and mortality if untreated. Current first\u2010line treatment involves corticosteroids and azathioprine (AZA<\/jats:styled-content>), which are effective but are associated with significant adverse effects and treatment intolerance. Mycophenolate mofetil (MMF<\/jats:styled-content>), an immunosuppressive agent with a potentially better safety profile, has emerged as an alternative. This meta\u2010analysis evaluated the efficacy and safety of MMF<\/jats:styled-content> compared to AZA<\/jats:styled-content> in treatment\u2010na\u00efve AIH<\/jats:styled-content> patients.<\/jats:p><\/jats:sec>Methods<\/jats:title>We conducted a systematic review and meta\u2010analysis in accordance with the Preferred Reporting Items for Systematic reviews and Meta\u2010Analyses guidelines. Databases were searched for articles published up to May 2024. Statistical analysis was performed using RevMan<\/jats:styled-content>, employing a random\u2010effects model.<\/jats:p><\/jats:sec>Results<\/jats:title>Five studies involving 621 patients were included. MMF<\/jats:styled-content> showed significantly higher rates of complete biochemical response compared to AZA<\/jats:styled-content> (odds ratio [OR<\/jats:styled-content>] 3.64, 95% confidence interval [CI<\/jats:styled-content>] 2.07\u20136.40, p<\/jats:italic>\u2009<\u20090.00001) and lower non\u2010response rates (OR<\/jats:styled-content> 0.45, 95% CI<\/jats:styled-content> 0.24\u20130.85, p<\/jats:italic>\u2009=\u20090.01). Corticosteroid withdrawal rates were also higher in the MMF<\/jats:styled-content> group (OR<\/jats:styled-content> 2.89, 95% CI<\/jats:styled-content> 1.69\u20134.94, p<\/jats:italic>\u2009=\u20090.0001). Relapse rate and cumulative prednisolone dose were comparable between the two groups. MMF<\/jats:styled-content> demonstrated a better safety profile, with significantly lower rates of gastrointestinal symptoms (OR<\/jats:styled-content> 0.46, 95% CI<\/jats:styled-content> 0.27\u20130.79, p<\/jats:italic>\u2009=\u20090.005).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>\nMMF<\/jats:styled-content> shows superior efficacy and tolerability compared to AZA<\/jats:styled-content> in treatment\u2010na\u00efve AIH<\/jats:styled-content> patients and may serve as a preferred first\u2010line therapy, offering improved patient adherence and clinical outcomes. Further randomized controlled trials are warranted to confirm these findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1751-2980.13348","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T10:30:48Z","timestamp":1747650648000},"page":"113-128","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["MMF<\/scp> Is an Effective and Safer Treatment Options for Treatment\u2010Na\u00efve Patients With Autoimmune Hepatitis Compared to Azathioprine: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"26","author":[{"given":"Muhammad Tayyab","family":"Anwar","sequence":"first","affiliation":[{"name":"Department of Internal Medicine John H. Stroger Jr. Hospital of Cook County Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4010-7545","authenticated-orcid":false,"given":"Muhammad","family":"Shahzil","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Milton S. Hershey Medical Center, The Pennsylvania State University Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4879-560X","authenticated-orcid":false,"given":"Taha Bin","family":"Arif","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Sinai Hospital of Baltimore Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Ali","family":"Khaqan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University of Kentucky Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edzel Lorraine","family":"Co","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Santo Tomas Faculty of Medicine and Surgery Sampaloc, Manila Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fariha","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Cooper University Hospital Camden New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rameez","family":"Tarar","sequence":"additional","affiliation":[{"name":"Department of Medicine King Edward Medical University Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Naeem","sequence":"additional","affiliation":[{"name":"Department of Medicine King Edward Medical University Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibgha","family":"Farooq","sequence":"additional","affiliation":[{"name":"Department of Medicine Avicenna Medical College Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Jaan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Rochester General Hospital Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammad Javaid","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Henry Ford Hospital Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay","family":"Jahagirdar","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition Virginia Commonwealth University Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reena","family":"Salgia","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Henry Ford Hospital Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.13584"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000001449"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-021-10170-1"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i1.60"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31065"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.06.030"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e3181a1c265"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22322"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.07.032"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1020166605016"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.09.037"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14513"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12381"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0162-3109(00)00188-0"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2022.100601"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.11.032"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0000000000001367"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2010.12.032"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15157"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_8_22_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.4","author":"Higgins J. P. T.","year":"2023"},{"key":"e_1_2_8_23_1","volume-title":"The Newcastle\u2010Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta\u2010Analyses","author":"Wells G. A.","year":"2014"},{"key":"e_1_2_8_24_1","volume-title":"GRADEpro Guideline Development Tool [Software]","author":"GRADEpro GDT","year":"2023"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/XEB.0000000000000141"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280216669183"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102288\u201014\u2010135"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280219889080"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.798602"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2008.04.006"},{"issue":"6","key":"e_1_2_8_31_1","first-page":"623","article-title":"Hellenic Association for the Study of the Liver (HASL): Revised Clinical Practice Guidelines for Autoimmune Hepatitis","volume":"37","author":"Dalekos G. N.","year":"2024","journal-title":"Annals of Gastroenterology"},{"issue":"3","key":"e_1_2_8_32_1","first-page":"302","article-title":"Autoimmune Hepatitis in Children: Experiences in a Tertiary Center","volume":"23","author":"Dehghani S.\u2010M.","year":"2013","journal-title":"Iranian Journal of Pediatrics"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v26.i38.5896"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.12.041"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15248"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtauto.2022.100172"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2011.12.002"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2006.05.011"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(02)00214-3"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v17.i37.4166"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/FPC.0000000000000010"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izab254"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2009.01.020"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.09.009"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2007.10.012"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V8101592"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(19)33223-8"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(73)92125-9"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.16.11.876"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.21.1.78"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199510123331502"}],"container-title":["Journal of Digestive Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1751-2980.13348","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T06:06:57Z","timestamp":1750918017000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1751-2980.13348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":50,"journal-issue":{"issue":"3-4","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1111\/1751-2980.13348"],"URL":"https:\/\/doi.org\/10.1111\/1751-2980.13348","archive":["Portico"],"relation":{},"ISSN":["1751-2972","1751-2980"],"issn-type":[{"value":"1751-2972","type":"print"},{"value":"1751-2980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]},"assertion":[{"value":"2025-01-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}