التهاب الكبد المناعي الذاتي: ماذا نفعل عندما يفشل الحث من الخط الأول في تحقيق الهدأة البيوكيميائية

References

DOI: 10.1016/j.jhep.2025.03.017

• MMF is recommended as the second-line treatment of choice in patients with intolerance or side effects to thiopurines (LoE 2, strong recommendation, strong consensus).
• MP or TG can be used in patients with intolerance to azathioprine (LoE 4, weak recommendation, strong consensus).
• After exclusion of non-adherence, intensification/optimisation of immunosuppression by increasing the dose of azathioprine up to 2 mg/kg/day (when 6-MMP is appropriately low) is recommended (LoE 3, strong recommendation, strong consensus).
• Addition of allopurinol (contraindicated in pregnancy) and reduction of the azathioprine dose to 25% (when 6-MMP is disproportionately increased) can be suggested as an alternative to the previous recommendation (LoE 3, weak recommendation, strong consensus).
• MMF may be used before initiating third-line therapies after unsuccessful intensification/optimisation of azathioprine-related therapies (LoE 2, weak recommendation, consensus).
• According to a recent report by the IAIHG,163 CBR was defined as normalisation of AST, ALT, and IgG levels no later than 6 months after treatment initiation (Table 7).