Treatment of autoimmune hepatitis

Corticosteroid therapy is effective in all forms of autoimmune hepatitis, and the combination of prednisone and azathioprine is preferred. Remission can be achieved in 80% of patients within 3 years, and the 10- and 20-year survival rates exceeded 80%. Histological cirrhosis does not affect response or lengevity, and all patients with severe disease should be treated, including children, elderly adults, postmenopausal women, individuals with accute or fulminant presentations, and those without conventional autoantibodies. Relapse is common, and long-term low-dose prednisone or azathroprine therapy is preferred after multiple relapses. Sustained remission is achievable, even after relapse, in 47% within 10 years, and the long-term maintenance regimens need not be indefinite. Liver transplantation is effective, and its actuarial 10-year survival rate is 75%. Drugs such as cyclosporine, tacrolimus and mycophenolate mofetil promise greater blanket immunosupression, and site-specific interventions are feasible, including blocking peptides, soluble cytotixic T lymphocyte antigen-4, cytokine manipulations, T cell vaccination, oral tolerance, and gene therapy.