[Treatment of Autoimmune Hepatitis]

Abstract

Autoimmune hepatitis (AIH) is a chronic liver disease, characterized by elevated levels of transaminases, immunoglobulin G, and positive autoantibodies. The disease course is dynamic and presents heterogeneous disease manifestations at diagnosis. This review summarizes the issues regarding the treatment and monitoring of AIH in adult patients. Glucocorticoids and azathioprine are the first line of treatment. Alternative first-line treatments include budesonide or mycophenolate mofetil (MMF). Although no randomized controlled trials have been performed, MMF, cyclosporine, tacrolimus, 6-mercaptopurine, 6-thioguanine, allopurinol, sirolimus, everolimus, infliximab, or rituximab have been attempted in patients not responding to or intolerant to first-line treatments. Most patients require life-long special monitoring, with or without maintenance treatment.

Keywords: Adult; Autoimmune hepatitis; Treatment.

Fig. 1

Induction strategy for autoimmune hepatitis as per the autoimmune hepatitis clinical practice guidelines of KASL (figure courtesy of the KASL). AIH, autoimmune hepatitis; AZA, azathioprine; DILI, drug-induced liver injury; HAI, hepatitis activity index; NUDT15, Nudix hydrolase 15; TPMT, thiopurine S-methyltransferase; KASL, Korean Association for the Study of the Liver. *Delayed institution of AZA by 2 weeks can be considered. ^†Emergent evaluation for liver transplantation should be considered for patients with acute liver failure.

Fig. 2

Maintenance strategy for patients with autoimmune hepatitis depicting the biochemical response to prednisolone and/or azathioprine induction therapy; extracted from the autoimmune hepatitis clinical practice guidelines of KASL (figure courtesy of the KASL). 6-MP, 6-mercaptopurine; 6-TG, 6-thioguanine; AZA, azathioprine; MMF, mycophenolate mofetil; KASL, Korean Association for the Study of the Liver.