First-Line Treatment of Autoimmune Hepatitis
This protocol covers first-line induction therapy for autoimmune hepatitis (AIH) in adults. The clinical objective is a complete biochemical response, assessed through serial liver function testing after treatment begins.
First-Line Approach
Induction therapy combines a corticosteroid with a complementary agent, with the corticosteroid subsequently tapered according to the biochemical response. The full regimen — including agent selection, sequencing, and tapering schedule — is defined in the structured protocol.
Treatment Goal
Complete biochemical response — defined as normalisation of AST, ALT, and IgG levels — is the target, expected no later than 6–12 months after treatment initiation.
References
DOI: 10.1016/j.jhep.2025.03.017
- In adults with AIH, predniso(lo)ne of at least 0.5 mg/kg/day, and potentially up to 1 mg/kg/day in more severe and advanced disease, in combination with azathioprine (whenever bilirubin is <6 mg/dl and ideally 2 weeks apart from corticosteroid start at an initial dose of 50 mg/day up to a final dose of 1-2 mg/kg/day) or mycophenolate mofetil (MMF, 1.5-2 g/day) should be the first-line treatments.
- Rapid corticosteroid tapering (e.g. 5-10 mg/1-2 weeks) is desirable but should follow response.
- 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).
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