Autoimmune hepatitis medical therapy

Autoimmune hepatitis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating autoimmune hepatitis differential diagnosis
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Diagnostic of choice
Laboratory Findings
Electrocardiogram
X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Autoimmune hepatitis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Autoimmune hepatitis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Autoimmune hepatitis medical therapy
CDC on Autoimmune hepatitis medical therapy
Autoimmune hepatitis medical therapy in the news
Blogs on Autoimmune hepatitis medical therapy
Directions to Hospitals Treating Autoimmune hepatitis
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:

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.

Contraindicated medications

Autoimmune hepatitis is considered an absolute contraindication to the use of the following medications:

• Pegylated interferon alfa-2b

Recommendations for the Treatment of Autoimmune Hepatitis (DO NOT EDIT)

“

Immunosuppressive treatment based on serum aspartate aminotransferase (AST), serum alanine aminotransferase (ALT), serum gamma-globulin levels, and histological features Prednisone or prednisolone with azathioprine (adults) Prednisone with azathioprine or 6-mercaptopurine (children) Prednisone or prednisolone alone Monitoring for bone disease Adjunctive therapies for bone disease (weight bearing exercise program, vitamin D and calcium supplementation, bisphosphonates) Pretreatment vaccination against hepatitis A virus (HAV) and hepatitis B virus (HBV) Management of treatment side effects and risks, including during pregnancy Alternative drug therapies for suboptimal response (cyclosporine, tacrolimus, or mycophenolate mofetil) Hepatic ultrasonography to detect hepatocellular carcinoma (HCC) Liver transplantation, management of recurrent disease after transplant with drug therapy and/or retransplantation in certain patients

”