Evidence map›Paper›PMID 41078044›Full record

SynthesisMedical principles and practice : international journal of the Kuwait University, Health Science Centre2026

Comparative Effectiveness of Mycophenolate Mofetil and Tacrolimus as a Second-Line Therapy for Autoimmune Hepatitis: A Systematic Review and Meta-Analysis.

Fahd Almalki, Sarah T Alarmati, Razan N Shata, Lama K Almatrfi, Salma A Binmahfoodh, Hana T Alomayri, Ghida'a S Qurban, Juri A Alzahrani, Lamar J Maddawi, Shatha M Alharbi and 4 more

Abstract readSystematic ReviewMeta-AnalysisComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Fahd AlmalkiDepartment of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia, fmamalki@uqu.edu.sa.
Sarah T AlarmatiCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Razan N ShataCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Lama K AlmatrfiCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Salma A BinmahfoodhCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Hana T AlomayriCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Ghida'a S QurbanCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Juri A AlzahraniCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Lamar J MaddawiCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Shatha M AlharbiCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Raghad F BahakeemCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Rawan S AzooniCollege of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Hassan AlwafiDepartment of Pharmacology and Toxicology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
Widya Normma InsaniDepartment of Pharmacology and Clinical Pharmacy, Padjadjaran University, Sumedang, Indonesia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveAutoimmune hepatitis (AIH) is a chronic immune-mediated liver disease that usually responds to corticosteroids ± azathioprine (AZA). However, some patients are intolerant or refractory to first-line therapy and require second-line immunosuppression. Mycophenolate mofetil (MMF) and tacrolimus (TAC) are commonly used alternatives, although comparative evidence is limited. This systematic review and meta-analysis evaluated the efficacy and safety of MMF and TAC in adult AIH patients who failed first-line therapy.

methodsA systematic search of six databases identified 16 eligible studies (n = 705), including retrospective cohorts and one case series. Study quality was assessed using the Newcastle-Ottawa Scale and the MMS (methodological quality and synthesis of case series and case reports) tool.

resultsBiochemical remission was achieved in 56% of MMF-treated patients, rising to 66% with ≥6-month follow-up. TAC showed a pooled remission rate of 66%, increasing to 67% when defined by transaminase normalization. MMF was particularly effective in AZA-intolerant patients, while TAC showed better outcomes in steroid-refractory patients. Adverse events differed: MMF was most often associated with gastrointestinal intolerance, whereas TAC was linked to tremor, hypertension, diabetes, and renal impairment. However, statistical analysis showed wide confidence intervals, and there was considerable heterogeneity across studies.

conclusionBoth MMF and TAC are effective second-line therapies for AIH. MMF appears safer and better tolerated in AZA-intolerant patients, while TAC showed a modest advantage in efficacy over mycophenolate in steroid-refractory cases. Given the limitations of current evidence, including small sample sizes, heterogeneity, and lack of randomized controlled trials, treatment choice should be individualized until higher quality data are available.

Indexed as

Hepatitis, AutoimmuneImmunosuppressive AgentsMycophenolic AcidTacrolimusHumansRemission InductionTreatment OutcomeImmunosuppressive AgentsMycophenolic AcidTacrolimusAutoimmune hepatitisBiochemical remissionMycophenolate mofetilSecond-line therapyTacrolimus

Identifiers

PMID41078044
PMCPMC13245972

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.