Treatment: Autoimmune Hepatitis

Indicated for symptomatic disease with biopsy evidence of severe chronic hepatitis (bridging necrosis), marked aminotransferase elevations (5- to 10-fold), and hypergammaglobulinemia. Prednisone or prednisolone 30-60 mg/d PO tapered to 10-15 mg/d over several weeks; often azathioprine 50 mg/d PO is also administered to permit lower glucocorticoid doses and avoid steroid side effects. Monitor liver function tests monthly. Symptoms may improve rapidly, but biochemical improvement may take weeks or months and subsequent histologic improvement (to lesion of mild chronic hepatitis or normal biopsy) up to 18-24 months. Therapy should be continued for at least 12-18 months. Relapse occurs in at least 50% of cases (re-treat). For frequent relapses, consider maintenance therapy with low-dose glucocorticoids or azathioprine 2 (mg/kg)/d.

For a more detailed discussion, see Dienstag JL: Chronic Hepatitis, Chap. 362, p. 2031, in HPIM-19.