Autoimmune hepatitis medical therapy: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Manpreet Kaur (talk | contribs)
nocaptcha
4,176 edits
Manpreet Kaur (talk | contribs)
nocaptcha
4,176 edits
Line 7: Line 7:
==Medical Therapy==
==Medical Therapy==
Mainstay treatment of autoimmune hepatitis is pharmacotherapy. Corticosteroids alone or in combination with immunosuppressants are commonly used.
Mainstay treatment of autoimmune hepatitis is pharmacotherapy. Corticosteroids alone or in combination with immunosuppressants are commonly used.
=== Acute Pharmacotherapies ===
=== Acute Pharmacotherapies ===
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for Autoimmune hepatitis include Prednisone alone and combination of Azathioprine and Prednisone.
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
===Autoimmune hepatitis:===
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===


* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''  
**** Preferred regimen (1): Prednisone 60mg PO q24h for 7 days ( '''Preference:Cytopenia, Thiopurine methyltransferase deficiency,''' '''Pregnancy, Malignancy, Short-course (<6 months)'''
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (2): Prednisone 40mg PO q24h for next 7 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Preferred regimen (3): Prednisone 30mg PO q24h for next 7 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days   
**** Preferred regimen (4): Prednisone 30mg PO q24h for next 7 days
**** Preferred regimen (5):  Prednisone 20mg and below PO q24h for maintenance until endpoint
**** Alternative regimen (1):Combination Therapy include Prednisone and Azathioprine  
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
Line 30: Line 27:
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
Line 98: Line 95:
|Weeks
|Weeks
|Dosage
|Dosage
|Prednisone* (mg/day)
|Prednisone
| colspan="2" |Azathioprine
| colspan="2" |Azathioprine
|-
|-

Revision as of 15:46, 15 December 2017

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:

Overview

Medical Therapy

Mainstay treatment of autoimmune hepatitis is pharmacotherapy. Corticosteroids alone or in combination with immunosuppressants are commonly used.

Acute Pharmacotherapies

  • Pharmacologic medical therapies for Autoimmune hepatitis include Prednisone alone and combination of Azathioprine and Prednisone.

Autoimmune hepatitis:

      • 1.1.1 Adult
        • Preferred regimen (1): Prednisone 60mg PO q24h for 7 days ( Preference:Cytopenia, Thiopurine methyltransferase deficiency, Pregnancy, Malignancy, Short-course (<6 months)
        • Preferred regimen (2): Prednisone 40mg PO q24h for next 7 days
        • Preferred regimen (3): Prednisone 30mg PO q24h for next 7 days
        • Preferred regimen (4): Prednisone 30mg PO q24h for next 7 days
        • Preferred regimen (5): Prednisone 20mg and below PO q24h for maintenance until endpoint
        • Alternative regimen (1):Combination Therapy include Prednisone and Azathioprine
        • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
        • Alternative regimen (3): drug name 500 mg PO q6h for 14–21 days
      • 1.1.2 Pediatric
        • 1.1.2.1 (Specific population e.g. children < 8 years of age)
          • Preferred regimen (1): drug name 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
          • Preferred regimen (2): drug name 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
          • Alternative regimen (1): drug name10 mg/kg PO q6h (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
        • 1.1.2.2 (Specific population e.g. 'children < 8 years of age')
          • Preferred regimen (1): drug name 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
          • Alternative regimen (1): drug name 10 mg/kg PO q6h (maximum, 500 mg per day)
          • Alternative regimen (2): drug name 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
          • Alternative regimen (3): drug name 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
    • 1.2 Specific Organ system involved 2
      • 1.2.1 Adult
        • Preferred regimen (1): drug name 500 mg PO q8h
      • 1.2.2 Pediatric
        • Preferred regimen (1): drug name 50 mg/kg/day PO q8h (maximum, 500 mg per dose)

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 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
  • Prednisone, 1 2 mg/kg daily (up to 60 mg/day),

for two weeks either alone or in combination

with azathioprine, 1 2 mg/kg daily

  • Prednisone taper over 6 8 weeks to

0.1 0.2 mg/kg daily or 5 mg daily

  • Azathioprine at constant dose if added initially
  • Continue daily prednisone dose with or without azathioprine or switch to alternate day prednisone dose adjusted to response with or without azathioprine
  • Normal liver tests for 1 2 years during treatment
  • No flare during entire interval
  • Liver biopsy examination discloses no inflammation

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)

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

References

Template:WS Template:WH

Retrieved from "https://www.wikidoc.org/index.php?title=Autoimmune_hepatitis_medical_therapy&oldid=1407716"