DOI: https://doi.org/10.22141/2308-2097.52.4.2018.154146

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

Yu.M. Stepanov, S.V. Kosynska

Abstract


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.


Keywords


autoimmune hepatitis; treatment; recommendations; practical experience

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