Title: Mycophenolate Mofetil Versus Azathioprine as a First-Line Treatment for Autoimmune
Hepatitis: A Comparative Systematic Review and Meta-Analysis
Version: 4 Date: 04 Jun 2025
Reviewer's report:
This comprehensive systematic review and Meta-Analysis  aimed to compare the efficacy
and safety of mycophenolate mofetil  versus azathioprine combined with steroids as first-line
treatment for the management of in treatment-naïve patients with autoimmune hepatitis. The
efficacy was assessed based on complete biochemical remission, non-response, and relapse
rates. Safety was evaluated on the basis of the incidence of serious adverse effects that led to
treatment discontinuation. After literature study selection, 4 studies met the inclusion criteria,
encompassing a total of 512 patients. The study shows that MMF combined with prednisolone
significantly improved both short-term CBR rates and long-term CBR rates compared to AZA
combined with prednisolone. MMF therapy was also associated with a significantly lower
occurrence of serious adverse events.
Therefore, the authors concluded that MMF-based first-line therapy for AIH appears to be a more
promising, effective, and safe treatment option, yielding higher CBR rates and fewer serious
adverse events requiring treatment discontinuation.
-The study, in my opinion, suffers from a potential bias due to the selection of three out of
four selected studies from the same center. This might reflect a different treatment approach
compared with other referral centers.
-A critical issue in a study comparing the first line combined with corticosteroid for the treatment
of AIH is the corticosteroid tapering schedules. International guidelines on AIH diagnosis and
treatment call for a biochemical (serum transaminases)-response based criterion for steroid
tapering. A slow steroid tapering is recommended to avoid biochemical response or incomplete
biochemical response.
-The authors should therefore describe how steroid therapy was administered with tapering
schedules.
Title: Mycophenolate Mofetil Versus Azathioprine as a First-Line Treatment for Autoimmune
Hepatitis: A Comparative Systematic Review and Meta-Analysis
Version: 4 Date: 04 Jun 2025
Reviewer's report:
This comprehensive systematic review and Meta-Analysis  aimed to compare the efficacy
and safety of mycophenolate mofetil  versus azathioprine combined with steroids as first-line
treatment for the management of in treatment-naïve patients with autoimmune hepatitis. The
efficacy was assessed based on complete biochemical remission, non-response, and relapse
rates. Safety was evaluated on the basis of the incidence of serious adverse effects that led to
treatment discontinuation. After literature study selection, 4 studies met the inclusion criteria,
encompassing a total of 512 patients. The study shows that MMF combined with prednisolone
significantly improved both short-term CBR rates and long-term CBR rates compared to AZA
combined with prednisolone. MMF therapy was also associated with a significantly lower
occurrence of serious adverse events.
Therefore, the authors concluded that MMF-based first-line therapy for AIH appears to be a more
promising, effective, and safe treatment option, yielding higher CBR rates and fewer serious
adverse events requiring treatment discontinuation.
-The study, in my opinion, suffers from a potential bias due to the selection of three out of
four selected studies from the same center. This might reflect a different treatment approach
compared with other referral centers.
-A critical issue in a study comparing the first line combined with corticosteroid for the treatment
of AIH is the corticosteroid tapering schedules. International guidelines on AIH diagnosis and
treatment call for a biochemical (serum transaminases)-response based criterion for steroid
tapering. A slow steroid tapering is recommended to avoid biochemical response or incomplete
biochemical response.
-The authors should therefore describe how steroid therapy was administered with tapering
schedules.
Please review this paper.
user
Title: Mycophenolate Mofetil Versus Azathioprine as a First-Line Treatment for Autoimmune
Hepatitis: A Comparative Systematic Review and Meta-Analysis
Version: 4 Date: 04 Jun 2025
Reviewer's report:
This comprehensive systematic review and Meta-Analysis  aimed to compare the efficacy
and safety of mycophenolate mofetil  versus azathioprine combined with steroids as first-line
treatment for the management of in treatment-naïve patients with autoimmune hepatitis. The
efficacy was assessed based on complete biochemical remission, non-response, and relapse
rates. Safety was evaluated on the basis of the incidence of serious adverse effects that led to
treatment discontinuation. After literature study selection, 4 studies met the inclusion criteria,
encompassing a total of 512 patients. The study shows that MMF combined with prednisolone
significantly improved both short-term CBR rates and long-term CBR rates compared to AZA
combined with prednisolone. MMF therapy was also associated with a significantly lower
occurrence of serious adverse events.
Therefore, the authors concluded that MMF-based first-line therapy for AIH appears to be a more
promising, effective, and safe treatment option, yielding higher CBR rates and fewer serious
adverse events requiring treatment discontinuation.
-The study, in my opinion, suffers from a potential bias due to the selection of three out of
four selected studies from the same center. This might reflect a different treatment approach
compared with other referral centers.
-A critical issue in a study comparing the first line combined with corticosteroid for the treatment
of AIH is the corticosteroid tapering schedules. International guidelines on AIH diagnosis and
treatment call for a biochemical (serum transaminases)-response based criterion for steroid
tapering. A slow steroid tapering is recommended to avoid biochemical response or incomplete
biochemical response.
-The authors should therefore describe how steroid therapy was administered with tapering
schedules.
assistant