J Gastroenterol Hepatol. 2010 Nov 15. doi: 10.1111/j.1440-1746.2010.06579.x. [Epub ahead of print]
Jothimani D, Cramp M, Mitchell J, Cross T.
The Southwest Liver Unit, Derriford Hospital, Plymouth, Devon, United Kingdom, PL6 8DH.
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 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 (MMF), cyclosporin (CyA), tacrolimus, 6-mercaptopurine (6-MP), 6-thioguanine (6-TG), rituximab, ursodeoxycholic acid (UDCA), 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.
© 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
PMID: 21073674 [PubMed - as supplied by publisher]
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