In older adults with autoimmune hepatitis, clinical presentation and histological findings on liver biopsy together determine whether immediate pharmacological intervention is warranted. When the patient is asymptomatic and biopsy shows only mild necroinflammatory activity without advanced fibrosis, the management pathway is distinct from higher-activity disease.
Clinical profile: Age ≥65 years · Asymptomatic · Mild necroinflammatory activity on liver biopsy · No advanced fibrosis. In this setting, current evidence supports a specific, structured approach rather than defaulting to standard induction therapy used in younger or more severely affected patients.
DOI: 10.1016/j.jhep.2025.03.017
A watch-and-wait strategy is recommended in elderly asymptomatic patients with mild activity and without advanced fibrosis (LoE 4, strong recommendation, strong consensus).
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