Treatment of autoimmune hepatitis: a review of current and evolving therapies.

Dinesh Jothimani; Matthew E. Cramp; Jonathon D. Mitchell; Tim J.S. Cross

doi:10.1111/j.1440-1746.2010.06579.x

Treatment of autoimmune hepatitis: a review of current and evolving therapies.

Dinesh Jothimani, Matthew E. Cramp, Jonathon D. Mitchell, Tim J.S. Cross^*

^*Corresponding author for this work

Peninsula Medical School

University Hospitals Plymouth NHS Trust

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Pages (from-to)	619-627
Number of pages	0
Journal	J Gastroenterol Hepatol
Volume	26
Issue number	4
DOIs	https://doi.org/10.1111/j.1440-1746.2010.06579.x
Publication status	Published - Apr 2011

Keywords

Drug Therapy
Combination
Evidence-Based Medicine
Hepatitis
Autoimmune
Humans
Immunosuppressive Agents
Practice Guidelines as Topic
Predictive Value of Tests
Treatment Outcome

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/j.1440-1746.2010.06579.x

Cite this

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title = "Treatment of autoimmune hepatitis: a review of current and evolving therapies.",

abstract = "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.",

keywords = "Drug Therapy, Combination, Evidence-Based Medicine, Hepatitis, Autoimmune, Humans, Immunosuppressive Agents, Practice Guidelines as Topic, Predictive Value of Tests, Treatment Outcome",

author = "Dinesh Jothimani and Cramp, {Matthew E.} and Mitchell, {Jonathon D.} and Cross, {Tim J.S.}",

year = "2011",

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AU - Jothimani, Dinesh

AU - Cramp, Matthew E.

AU - Mitchell, Jonathon D.

AU - Cross, Tim J.S.

PY - 2011/4

Y1 - 2011/4

N2 - 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.

AB - 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.

KW - Drug Therapy

KW - Combination

KW - Evidence-Based Medicine

KW - Hepatitis

KW - Autoimmune

KW - Humans

KW - Immunosuppressive Agents

KW - Practice Guidelines as Topic

KW - Predictive Value of Tests

KW - Treatment Outcome

U2 - 10.1111/j.1440-1746.2010.06579.x

DO - 10.1111/j.1440-1746.2010.06579.x

M3 - Article

SN - 1440-1746

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EP - 627

JO - J Gastroenterol Hepatol

JF - J Gastroenterol Hepatol

IS - 4

ER -

Treatment of autoimmune hepatitis: a review of current and evolving therapies.

Abstract

Keywords

UN SDGs

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