AUTOIMMUNE HEPATITIS - CURRENT THERAPEUTIC CONCEPTS

Prednisone alone or in combination with azathioprine is effective in the treatment of patients with severe autoimmune hepatitis. The major consequences of therapy are amelioration of symptoms and enhancement of immediate survival. Patients who are most likely to realise these benefits must be rigorously selected for treatment, as the diagnosis of autoimmune hepatitis per se does not compel therapy. Autoimmune hepatitis is not an easy diagnosis; institution of corticosteroid therapy is not a simple decision; and demonstration of a favourable response to initial therapy is not the end-point of treatment. Cure of the disease and prevention of cirrhosis should not be the primary goals of treatment, as the consistent procurement of these results has not been demonstrated. Suboptimal responses to treatment are common and guidelines for the confident management of these outcomes have not been fully developed. Relapse after drug withdrawal is frequent and its management requires highly individualised care. Liver transplantation should be considered only after the response to corticosteroid treatment has been assessed. Tacrolimus (FK-506), ursodeoxycholic acid and cytoprotective agents have promise as primary or adjunctive therapies, but their efficacy has not been established.