Autoimmune hepatitis medical therapy: Difference between revisions
No edit summary |
No edit summary |
||
Line 113: | Line 113: | ||
* The regular weight-bearing exercise program, vitamin D, calcium supplementation and bisphosphonates should be taken by patient who is taking corticosteriod for long term | * The regular weight-bearing exercise program, vitamin D, calcium supplementation and bisphosphonates should be taken by patient who is taking corticosteriod for long term | ||
* Vaccination against hepatitis B virus (HBV) and hepatitis A virus (HAV) should be done as early as possible even before immunosuppression | * Vaccination against hepatitis B virus (HBV) and hepatitis A virus (HAV) should be done as early as possible even before immunosuppression | ||
'''According to American Association for the Study of Liver Diseases, Immunosuppressive Treatment Regimens for Children in Autoimmune Hepatitis''': | |||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="3" |Immunosuppressive Treatment Regimens for Children in Autoimmune Hepatitis | ! colspan="3" |Immunosuppressive Treatment Regimens for Children in Autoimmune Hepatitis |
Revision as of 20:32, 14 December 2017
Autoimmune hepatitis Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Autoimmune hepatitis medical therapy On the Web |
American Roentgen Ray Society Images of Autoimmune hepatitis medical therapy |
Risk calculators and risk factors for Autoimmune hepatitis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Medical Therapy
Mainstay treatment of autoimmune hepatitis is pharmacotherapy. Corticosteroids alone or in combination with immunosuppressants are commonly used.
Acute Pharmacotherapies
According to American Association for the Study of Liver Diseases indications for immunosuppressive treatment:
Indications for Immunosuppressive Treatment | ||
---|---|---|
Absolute Indications | Relative Indications | None |
Serum AST >10 fold upper limit of normal range(ULN) | Symptoms like fatigue, arthralgia, jaundice | Asymptomatic with normal or near normal serum
AST and gamma globulin levels |
Serum AST >5 fold ULN | Serum AST and/or gamma globulin less than absolute criteria | Inactive cirrhosis or mild portal inflammation
(portal hepatitis) |
Gamma globulin level>2 fold ULN | Interface hepatitis | Severe cytopenia (white blood cell counts
<2.5 x109/L or platelet counts <50 x 109/L) |
Bridging necrosis or multiacinar
necrosis on histological examination |
Osteopenia, emotional instability, hypertension, diabetes,
or cytopenia (white blood cell counts <2.5 x109/L or platelet counts <50 x109/L) |
complete deficiency of TPMT activity
precludes treatment with azathioprine |
Incapacitating symptoms such as fatigue
and arthralgia |
Vertebral compression, psychosis, brittle diabetes,
uncontrolled hypertension, known intolerances to prednisone or azathioprine |
According to American Association for the Study of Liver Diseases, Immunosuppressive Treatment Regimens for Adults in Autoimmune Hepatitis:
Immunosuppressive Treatment Regimens for Adults in Autoimmune Hepatitis | ||||
Monotherapy
Prednisone only* (mg/day) |
Combination Therapy | |||
Weeks | Dosage | Prednisone* (mg/day) | Azathioprine | |
First | 60 | 30 | USA (mg/day) | EU (mg/kg/day) |
Second | 40 | 20 | 50 | 12 |
Third | 30 | 15 | 50 | 12 |
Fourth | 30 | 15 | 50 | 12 |
Maintenance until endpoint | 20 and below | 10 | 50 | 12 |
Reasons for Preference | Cytopenia, Thiopurine methyltransferase deficiency,
Pregnancy, Malignancy, Short-course (<6 months) |
Postmenopausal state, Brittle diabetes, Obesity, Acne,
Emotional lability, Hypertension |
Adjunctive therapies:
- Adjunctive therapy is based on medication and complication occurs due to medication
- The regular weight-bearing exercise program, vitamin D, calcium supplementation and bisphosphonates should be taken by patient who is taking corticosteriod for long term
- Vaccination against hepatitis B virus (HBV) and hepatitis A virus (HAV) should be done as early as possible even before immunosuppression
According to American Association for the Study of Liver Diseases, Immunosuppressive Treatment Regimens for Children in Autoimmune Hepatitis:
Immunosuppressive Treatment Regimens for Children in Autoimmune Hepatitis | ||
---|---|---|
Initial Regimen | Maintenance Regimen | Endpoint |
for two weeks either alone or in combination with azathioprine, 1 2 mg/kg daily |
0.1 0.2 mg/kg daily or 5 mg daily
|
|
Contraindicated medications
Autoimmune hepatitis is considered an absolute contraindication to the use of the following medications:
Recommendations for the Treatment of Autoimmune Hepatitis (DO NOT EDIT)
“ |
|
” |