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Treatment of autoimmune hepatitis: A review of current and evolving therapies
Author(s) -
Jothimani Dinesh,
Cramp Matthew E,
Mitchell Jonathon D,
Cross Tim J S
Publication year - 2011
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2010.06579.x
Subject(s) - medicine , autoimmune hepatitis , intensive care medicine , current (fluid) , hepatitis , immunology , electrical engineering , engineering
Autoimmune hepatitis (AIH) is an immune‐mediated necroinflammatory condition of the liver. Presentation can vary from the asymptomatic individual with abnormal liver function test to fulminant liver failure. The diagnosis is based on the combination of biochemical, autoimmune, and histological parameters, and exclusion of other liver diseases. Standard therapy consists of a combination of corticosteroids and azathioprine, which is efficacious in 80% of patients. Alternative therapies are increasingly being explored in patients who do not respond to the standard treatment and/or have unacceptable adverse effects. This review examines the role of alternative drugs (second‐line agents) available for AIH treatment non‐responders. These agents include budesonide, mycophenolate mofetil, cyclosporin, tacrolimus, 6‐mercaptopurine, 6‐thioguanine, rituximab, ursodeoxycholic acid, rapamycin, and methotrexate. In addition, the risk of opportunistic infections and malignancies are discussed. A treatment algorithm is proposed for the management of patients with AIH treatment non‐responders.