This protocol is for children under 18 years of age with confirmed autoimmune hepatitis. Paediatric management generally mirrors adult guidance, with specific adaptations — particularly around corticosteroid weaning — to prevent corticosteroid-related complications including growth failure.
First-line therapy — a combination of predniso(lo)ne and azathioprine (with ursodeoxycholic acid added when an AIH/PSC overlap is confirmed) — has been attempted but has not achieved biochemical remission. This failure to reach biochemical remission is the criterion that triggers escalation to the next step.
In children with treatment-refractory autoimmune hepatitis, a second-line immunosuppressive agent is used as a replacement for azathioprine. The complete regimen, specific agent selection, and paediatric dosing considerations are detailed in the full structured protocol.
DOI: 10.1016/j.jhep.2025.03.017
Treatment of AIH in children should follow the same guidance as in adults except for tailored weaning of predniso(lo)ne to a maintenance dose of 2.5-5 mg/day to avoid corticosteroid-related side effects including growth failure (LoE 2, strong recommendation, strong consensus).
MMF is the preferred agent to be used as second/third-line treatment followed by calcineurin inhibitors (Table 12).
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