Autoimmune hepatitis medical therapy: Difference between revisions
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== Acute Pharmacotherapies == | ==Medical Therapy== | ||
=== Acute Pharmacotherapies === | |||
* Despite our clear understanding of the pathogenesis and pathophysiology of AH, approximately 80 % of patients will have a good initial response to corticosteroids, with a ten-year survival rate approaching 90%. | * Despite our clear understanding of the pathogenesis and pathophysiology of AH, approximately 80 % of patients will have a good initial response to corticosteroids, with a ten-year survival rate approaching 90%. | ||
* The decision to treat patients with only mild disease is often based on symptoms. | * The decision to treat patients with only mild disease is often based on symptoms. | ||
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* There are no firm guidelines concerning the tapering or discontinuation of therapy. | * There are no firm guidelines concerning the tapering or discontinuation of therapy. | ||
==Recommendations for the | ==Recommendations for the Treatment of Autoimmune Hepatitis (DO NOT EDIT)== | ||
{{cquote| | {{cquote| | ||
# Immunosuppressive treatment based on serum aspartate aminotransferase (AST), serum alanine aminotransferase (ALT), serum gamma-globulin levels, and histological features | # Immunosuppressive treatment based on serum aspartate aminotransferase (AST), serum alanine aminotransferase (ALT), serum gamma-globulin levels, and histological features | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Autoimmune Disease]] | |||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
Revision as of 18:43, 27 February 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Medical Therapy
Acute Pharmacotherapies
- Despite our clear understanding of the pathogenesis and pathophysiology of AH, approximately 80 % of patients will have a good initial response to corticosteroids, with a ten-year survival rate approaching 90%.
- The decision to treat patients with only mild disease is often based on symptoms.
- Asymptomatic patients with mild inflammation on Bx can be observed with careful monitoring of histology.
- The goal of therapy is generally normalization of both transaminases and histology, and in general, most patients who are going to respond do so by 6 months.
- Unfortunately, the results with alternate-day or pulsed steroid regimens have been disappointing and daily regimens are preferred.
- Azathioprine can be used as a steroid-sparing agent.
- Additionally, some authors recommend using lower prednisone doses with the goal of partial suppression of disease, as opposed to higher doses of steroids with the goal being remission.
- For the 10 – 20% of patients who develop progressive disease despite steroids and/or azathioprine, cyclosporine and tacrolimus have recently been shown to induce remission.
- There are no firm guidelines concerning the tapering or discontinuation of therapy.
Recommendations for the Treatment of Autoimmune Hepatitis (DO NOT EDIT)
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