Treatment of Autoimmune Hepatitis in AIH / Primary Biliary Cholangitis Variant Syndrome with Concomitant Cholestatic Features
Clinical Scenario
Overlap syndrome
This protocol addresses patients with the autoimmune hepatitis / primary biliary cholangitis (AIH/PBC) variant syndrome — an overlap condition in which features of both autoimmune hepatitis and primary biliary cholangitis coexist, accompanied by concomitant cholestatic features. Treatment selection in this population is determined by the severity of the hepatitis component, assessed through biochemical parameters and liver histological findings.
Treatment Approach
Partial overview
Management centres on ursodeoxycholic acid (UDCA), used alone or in combination with standard immunosuppressive therapy depending on hepatitis severity. The precise selection criteria, escalation pathway, and response-based adjustments are detailed in the full protocol.
Treatment Goals
- Complete biochemical response: normalisation of AST, ALT, and IgG levels
References
DOI: 10.1016/j.jhep.2025.03.017
- In patients with AIH/PBC, the initial treatment regimen should be determined according to biochemical parameters and liver histological findings.
- Combination of standard immunosuppressive therapy with UDCA (13-15 mg/kg/day) can be used in those with moderate or severe hepatitis, while UDCA monotherapy can be used in those with mild hepatitis followed by addition of immunosuppressive therapy if they do not achieve CBR (LoE 4, weak recommendation, strong consensus).
- According to a recent report by the IAIHG, CBR was defined as normalisation of AST, ALT, and IgG levels no later than 6 months after treatment initiation.
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