This protocol addresses patients with autoimmune hepatitis who have not achieved a complete biochemical response despite second-line immunosuppressive adjustments and who remain difficult to treat. Care in this setting requires management at an expert centre.
The preceding treatment step — encompassing agents such as mycophenolate mofetil, mercaptopurine, thioguanine, azathioprine intensification, or allopurinol combination — did not achieve the required goal: complete biochemical response (normalisation of AST, ALT, and IgG levels). This failure of second-line therapy is the condition that activates the third-line rescue protocol below.
In difficult-to-treat patients managed at expert centres, escalation involves a selected targeted biological or immunomodulatory agent. The specific agent chosen, the full structured regimen, and monitoring requirements are set out in the complete protocol.
Target: normalisation of AST, ALT and IgG