First-Line Treatment for Autoimmune Hepatitis Without Cirrhosis or Acute Severe AIH

This protocol addresses children and adults presenting with autoimmune hepatitis who do not have cirrhosis, acute severe AIH, or acute liver failure — a distinct sub-population for which guideline-based first-line recommendations are well established.

Autoimmune hepatitis confirmed, without evidence of cirrhosis, without features of acute severe AIH, and without acute liver failure. This presentation is appropriate for standard first-line induction and maintenance therapy.

The target is biochemical remission: normalization of serum ALT, AST, and IgG levels. Serum aminotransferase levels are expected to improve within 2 weeks of starting treatment, with full biochemical remission ideally achieved within 6 months.

First-line therapy involves a corticosteroid combined with an immunosuppressant, administered through a structured induction phase. Once biochemical remission is reached, a gradual taper to a lower maintenance dose follows. The complete regimen — including agent selection, sequencing, and monitoring criteria — is in the full protocol.