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The Treatment of Autoimmune Hepatitis.
MedLine Citation:
PMID:  22794160     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Autoimmune hepatitis is an immune-mediated disease targeting hepatocytes. It is more common in middle-aged Caucasian females, although may affect other patient populations and age groups. The diagnosis is made according to criteria based on the alkaline phosphatase: ALT ratio, IgG, the presence of autoantibodies, liver histology, response to therapy, and the absence of a viral, alcohol or drug etiology . More recently a simplified scoring system has been proposed. In the absence of treatment , the prognosis is very poor with a 60% three year mortality. There are guidelines on the indications for treatment and some groups of patients may not require treatment. The main element of treatment is prednisolone which decreases the 3 year mortality to 10%. Prednisolone is tapered down to 5-10 mg per day, as monotherapy or in combination with azathioprine. Approximately 80% of patients will respond to therapy with prednisolone with or without azathioprine and this should be given for at least 2 years. Remission is defined as an asymptomatic patient with serum aminotransferases that are normal or less than two-fold elevated , a normal level of IgG and inactive liver histology. Relapse occurs in up to 90% of patients following drug withdrawal. The sensitivity and specificity of liver histology to predict relapse off treatment is not high. Other treatments that have been proposed include mycophenolate mofetil, budesonide, cyclosporine A, tacrolimus, 6-MP, methotrexate, ursodeoxycholic acid, rapamycin and rituximab although experience with all these agents is limited.
Authors:
Stephen Malnick; Gabriel Duek; Ehud Melzer; Alon Basevitz
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-09
Journal Detail:
Title:  Current clinical pharmacology     Volume:  -     ISSN:  2212-3938     ISO Abbreviation:  Curr Clin Pharmacol     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101273158     Medline TA:  Curr Clin Pharmacol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Internal Medicine C, Gastroenterology Institute, Kaplan Medical Center, Rehovot 76100, Israel. stephen@malnick.net.
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