This protocol applies to children and adults with autoimmune hepatitis who do not have cirrhosis, acute severe AIH, or acute liver failure — and in whom first-line immunosuppressive therapy has resulted in treatment failure, an incomplete response, or drug intolerance.
Standard first-line therapy — budesonide combined with azathioprine, or prednisone/prednisolone combined with azathioprine — aims to achieve biochemical remission: normalization of serum ALT, AST, and IgG levels. When this goal is not reached, or when the patient cannot tolerate first-line agents, escalation to a second-line protocol is indicated.
In this setting, second-line immunosuppressive therapy is considered. One specific agent is generally preferred as the initial second-line choice, with an alternative immunosuppressive option available for patients in whom the preferred agent is not suitable.
Achievement and maintenance of biochemical remission, defined as normalization of serum AST, ALT, and IgG levels.
DOI: 10.1002/hep.31065
For children and adults who present with AIH who do not have cirrhosis or acute severe AIH, the AASLD suggests that budesonide and AZA or prednisone/prednisolone and AZA be used as first-line treatment.
In children or adults with AIH who have treatment failure, incomplete response, or drug intolerance to first-line agents, the AASLD suggests the use of MMF or TAC to achieve and maintain biochemical remission (conditional recommendation, low certainty).
Based on a superior ease of use and side-effect profile, the AASLD suggests a trial of MMF over TAC as the initial second-line agent in patients with AIH (conditional recommendation, very low certainty).
View source ↗