Treatment of autoimmune hepatitits according to the national, international recommendations and own experience

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Yu.M. Stepanov
S.V. Kosynska


Autoimmune hepatitis (AIH) is rare liver pathology, but there is the increase in the number of patients over the last years. There is no unambiguous determination or clear pathognomonic criteria of AIH. A presence of autoantibodies, hypergammaglobulinemia, characteristic morphological changes and response to immunosuppressive therapy are inherent for AIH. Immunosupressive therapy must provide the control of autoimmune process, elimination of inflammatory syndrome, fibrosis reduction, slowing down the development of cirrhosis. The first-line drugs in AIH are corticosteroids and azathioprine, more effective than placebo. Prednisolone is prescribed at a dose of 40–60 mg/day, individual dose is 0.5–1 mg/kg/day. The higher the activity of cytolysis, the larger the required dose of prednisolone. When cytolysis is reduced according to hepatic tests, the dose of prednisolone is decreased. Methylprednisolone is used more often in practice. Azathioprine is administered either immediately or 2 weeks after prednisolone at a dose 50 mg/day with a possible increase to 100 mg/day, individual dose is 1–2 mg/kg/day. Now preference is given to combination therapy with prednisolone and azathioprine. Assessment of the effectiveness of AIH treatment involves monitoring the level of aminotransferases and immunoglobulin G, their complete norma­lization is desirable. To evaluate fibrosis, we used liver elastography. Treatment is actually life long. The second-line drugs are mycophenolate mofetil, cyclosporine, tacrolimus, sirolimus, everolimus and other. The mycophenolate mofetil is considered most stu­died. The search for effective AIG therapy continues, methods of cellular, anticytokine, antifibrotic therapies are being developed. Clinical examples from own experience are presented. Treatment of AIH is a difficult process. Modern recommendations, data from the stu­dies and accumulated experience help considerably. The choice of therapy requires individual approach, taking into account the features of clinical course and response to therapy.

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Stepanov, Y., & Kosynska, S. (2018). Treatment of autoimmune hepatitits according to the national, international recommendations and own experience. GASTROENTEROLOGY, 52(4), 254–261.
Reviews and Lections


Czaja AJ. Diagnosis and Management of Autoimmune Hepatitis: Current Status and Future Directions. Gut Liver. 2016 Mar;10(2):177-203. doi: 10.5009/gnl15352.

Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D. Autoimmune hepatitis: Standard treatment and systematic review of alternative treatments. World J Gastroenterol. 2017 Sep;23(33):6030-6048. doi: 10.3748/wjg.v23.i33.6030.

Liwinski T, Schramm C. Autoimmune hepatitis - update on clinical management in 2017. Clin Res Hepatol Gastroenterol. 2017 Dec;41(6):617-625. doi: 10.1016/j.clinre.2017.07.002.

Gatselis NK, Zachou K, Koukoulis GK, Dalekos GN. Autoimmune hepatitis, one disease with many faces: etiopathogenetic, clinico-laboratory and histological characteristics. World J Gastroenterol. 2015 Jan; 21(1):60-83. doi: 10.3748/wjg.v21.i1.60.

Van Gerven NM, de Boer YS, Mulder CJ, et al. Auto immune hepatitis. World J Gastroenterol. 2016 May;22(19):4651-61. doi: 10.3748/wjg.v22.i19.4651.

Manns MP, Lohse AW, Vergani D. Autoimmune hepatitis--Update 2015. J Hepatol. 2015 Apr;62(1 Suppl):S100-11. doi: 10.1016/j.jhep.2015.03.005.

Than NN, Jeffery HC, Oo YH. Autoimmune Hepatitis: Progress from Global Immunosuppression to Personalised Regulatory T Cell Therapy. Can J Gastroenterol Hepatol. 2016;2016:7181685. doi: 10.1155/2016/7181685.

Stepanov YuM, Kosynska SV, Pavlenko OV. Management of patients with autoimmune liver diseases on the basis of the latest EASL recommendations and our own experience (lecture to a practical doctor). Pathologia. 2018;(1):101-108. doi: 10.14739/2310-1237.2018.1.127703. (in Ukrainian).

Baven-Pronk MA, Biewenga M, van Silfhout JJ, et al. Role of age in presentation, response to therapy and outcome of autoimmune hepatitis. Clin Transl Gastroenterol. 2018 Jul;9(6):165. doi: 10.1038/s41424-018-0028-1.

European Association for the Study of the Liver. EASL clinical practice guidelines: autoimmune hepatitis. J Hepatol. 2015 Oct;63(4):971-1004. doi: 10.1016/j.jhep.2015.06.030.

Muratori P, Lalanne C, Fabbri A, Cassani F, Lenzi M, Muratori L. Type 1 and type 2 autoimmune hepatitis in adults share the same clinical phenotype. Aliment Pharmacol Ther. 2015 Jun;41(12):1281-7. doi: 10.1111/apt.13210.

Danielsson Borssen A , Marschall HU, Bergquist A, et al. Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitis. Scand J Gastroenterol. 2017 Sep;52(9):1022-1028. doi: 10.1080/00365521.2017.1335772.

To U, Silveira M. Overlap Syndrome of Autoimmune Hepatitis and Primary Biliary Cholangitis. Clin Liver Dis. 2018 Aug;22(3):603-611. doi: 10.1016/j.cld.2018.03.010.

Vierling JM. Autoimmune Hepatitis and Overlap Syndromes: Diagnosis and Management. Clin Gastroenterol Hepatol. 2015 Nov;13(12):2088-108. doi: 10.1016/j.cgh.2015.08.012.

Lammert С, Loy VM, Oshima K, Gawrieh S. Management of Difficult Cases of Autoimmune Hepatitis. Curr Gastroenterol Rep. 2016 Feb;18(2):9. doi: 10.1007/s11894-015-0484-7.

Zachou K, Arvaniti P, Azariadis K, et al. Prompt initiation of high-dose i.v. corticosteroids seems to prevent progression to liver failure in patients with original acute severe autoimmune hepatitis. Hepatol Res. 2018 Sep 24. doi: 10.1111/hepr.13252.

European Association for the Study of the Liver, et al. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017 May;66(5):1047-1081. doi: 10.1016/j.jhep.2016.12.003.

Ichai P, Duclos-Vallée J-C, Guettier C, et al. Usefulness of corticosteroids for the treatment of severe and fulminant forms of autoimmune hepatitis. Liver Transpl. 2007 Jul;13(7):996-1003. doi: 10.1002/lt.21036. 

Miśkiewicz P, Jankowska A, Brodzińska K, Milczarek-Banach J, Ambroziak U. Influence of Methylprednisolone Pulse Therapy on Liver Function in Patients with Graves' Orbitopathy. Int J Endocrinol. 2018 Oct 21; 2018:1978590. doi: 10.1155/2018/1978590.

Park SW, Um SH, Lee HA, et al. Mycophenolate mofetil as an alternative treatment for autoimmune hepatitis. Clin Mol Hepatol. 2016 Jun;22(2):281-5. doi: 10.3350/cmh.2015.0040.

van den Brand FF, van Nieuwkerk CMJ,Verwer BJ, et al. Biochemical efficacy of tioguanine in autoimmune hepatitis: a retrospective review of practice in the Netherlands. Aliment Pharmacol Ther. 2018 Oct;48(7):761-767. doi: 10.1111/apt.14939.

Bolia R, Rajanayagam J, Hardikar W. Lower 6-MMP/6-TG Ratio May Be a Therapeutic Target in Pediatric Autoimmune Hepatitis. J Pediatr Gastroenterol Nutr. 2018 Dec;67(6):695-700. doi: 10.1097/MPG.0000000000002146.

Simsek M, Meijer B, Mulder CJJ, van Bodegraven AA, de Boer NKH. Analytical Pitfalls of Therapeutic Drug Monitoring of Thiopurines in Patients With Inflammatory Bowel Disease. Ther Drug Monit. 2017 Dec;39(6):584-588. doi: 10.1097/FTD.0000000000000455.

Lim SZ, Chua EW. Revisiting the Role of Thiopurines in Inflammatory Bowel Disease Through Pharmacogenomics and Use of Novel Methods for Therapeutic Drug Monitoring. Front Pharmacol. 2018 Oct 8;9:1107. doi: 10.3389/fphar.2018.01107.

Liberal R, de Boer YS, Andrade RJ, et al. Expert clinical management of autoimmune hepatitis in the real world. Aliment Pharmacol Ther. 2017 Mar;45(5):723-732. doi: 10.1111/apt.13907.

Lu FB, Hu ED, Xu LM, et al. Comparative efficacy and tolerability of treatments for adult autoimmune hepatitis: A systematic review and network meta-analysis. Exp Ther Med. 2018 Jun;15(6):4838-4850. doi: 10.3892/etm.2018.6063.

Giannakopoulos G, Verbaan H, Friis-Liby IL, et al. Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapywith prednisolone and azathioprine. Dig Liver Dis. 2018 Oct 12. pii: S1590-8658(18)31178-2. doi: 10.1016/j.dld.2018.10.004.

De Lemos-Bonotto M, Valle-Tovo C, Costabeber AM, et al. A systematic review and meta-analysis of second-line immunosuppressants for autoimmune hepatitis treatment. Eur J Gastroenterol Hepatol. 2018 Feb;30(2):212-216. doi: 10.1097/MEG.0000000000001019.

Zizzo AN, Valentino PL, Shah PS, Kamath BM. Second-line Agents in Pediatric Patients With Autoimmune Hepatitis: A Systematic Review and Meta-analysis. J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):6-15. doi: 10.1097/MPG.0000000000001530.

Efe C, Hagström H, Ytting H, et al. Efficacy and Safety of Mycophenolate Mofetil and Tacrolimus as Second-line Therapy or Patients With Autoimmune Hepatitis. Clin Gastroenterol Hepatol. 2017 Dec;15(12):1950-1956.e1. doi: 10.1016/j.cgh.2017.06.001.

Taubert R, Hupa-Breier KL, Jaeckel E, Manns MP. Novel therapeutic targets in autoimmune hepatitis. J Autoimmun. 2018 Nov 3. pii: S0896-8411(18)30601-2. doi: 10.1016/j.jaut.2018.10.022.

Dhaliwal HK, Hoeroldt BS, Dube AK, et al. Long-Term Prognostic Significance of Persisting Histological Activity Despite Biochemical Remission in Autoimmune Hepatitis. Am J Gastroenterol. 2015 Jul;110(7):993-9. doi: 10.1038/ajg.2015.139.

Montano-Loza AJ, Thandassery RB, Czaja AJ. Targeting Hepatic Fibrosis in Autoimmune Hepatitis. Dig Dis Sci. 2016 Nov;61(11):3118-3139.

Farkas S, Hackl C, Schlitt HJ. Overview of the indications and contraindications for liver transplantation. Cold Spring Harb Perspect Med. 2014 May 1;4(5). pii: a015602. doi: 10.1101/cshperspect.a015602.

European Association for the Study of the Liver. EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. J Hepatol. 2017 Jul;67(1):145-172. doi: 10.1016/j.jhep.2017.03.022.

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