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Dear Colleagues If you have missed Dr. Jose Checa's talk, you can view "Hepatotoxicity SIG Monthly Seminar Series May 2022.mp4" at: https://acrobat.adobe.com/link/track?uri=urn:aaid:scds:US:31546f01-2f77-49ae-9428-df17cb380d02 Thanks for ... Login

Hello, I appreciate all the great discussion! I should clarify that the patient is currently on MMF 1.5gm BID. I will also say it crossed my mind that she may not have truly failed azathioprine, as I don't think metabolites were checked during the 2018 ... Login

Good discussion here. Michele, have you given consideration to increasing MMF to 1.5 g bid? That is an option if patient is tolerating treatment well. ------------------------------ Cynthia Levy MD, FAASLD Professor of Clinical Medicine University of ... Login

HI Michele and thanks so much for sending this! I agree with the comments so far. I have numerous patients with AIH/PBC overlap like this and they tend to be harder to control and often do need a more aggressive immunosuppressive regimen. She already ... Login

So I am with Ansgar.  You haven't convinced me at all that the risks of immunosuppression are indicated.  I will be honest I don't know what you are treating- just liver numbers?  And how are you sure that this isn't PBC that is under responsive to UDCA?  ... Login

Dear Nandy, Dear Michele, I disagree  - and I believe that is what these gorups are good for: why are both of you so aggressive in your therapy of this lady who has made it to 68 with little fibrosis. Biopsy said F2, but firboscan says 3.3kPA, ... Login

Hi Michele :) She is heading towards cirrhosis if she isn’t already there which I suspect she is not just based on imaging (AST > ALT)… I don’t think you have much choice. I agree with you to switch or add CNI. In my experience some of these patients ... Login

Good day to all, I believe a liver biopsy would be important at this time, because this patient might have developed NASH. However, empiric evidences such as worsening of liver tests when decreasing budesonide suggest worsening AIH activity . Calcineurin ... Login

Dear Michele, I would also prefer switching to Tacrolimus and tapering off budesonide. Best wishes Rohit -- Dr. Rohit Mehtani Login

Dear Michele I would favor switching to Tacrolimus and keeping low trough levels, provided adrenal insufficiency Is not an issue at this time. Not sure whether the steroid sparing effect of Budesonide is good when the liver is cirrhotic. In ... Login