Abstract
Autoimmune liver disease management goals are primarily slowing disease progression and symptomatic treatment. There are few options for curative medical management other than transplant for a spectrum of autoimmune liver disease that encompasses autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis as well as their overlap syndromes. These diseases are managed primarily with immunosuppressive therapy. Herein, we review the current literature, detailing the promise and pitfalls of the recommended immunosuppressive therapy for these challenging diseases.
Highlights
Immunosuppressant therapy is a critical component of treatment in autoimmune mediated liver disease
Owing to the complex nature of immune mediated organ injury, immunosuppressive therapy has two principal effects, each resulting in specific benefits and harms
Patients who failed to respond to ursodeoxycholic acid (UDCA) after 1 year of treatment were started on colchicine for 6 months and if there was no response methotrexate (0.25 mg/kg per week) was added
Summary
Immunosuppressant therapy is a critical component of treatment in autoimmune mediated liver disease. This study investigated 91 PBC patients who failed to respond to UDCA after 1 year of treatment were started on colchicine for 6 months and if there was no response methotrexate (0.25 mg/kg per week) was added. Their results showed a significant improvement in biochemical tests and histology in 73 of 91 patients. Drugs such as prednisone, cyclosporine, azathioprine and D-penicillamine are generally not recommended owing to their toxic side effects and limited clinical experience [41,42,43,44]. Associated with higher risk of adverse events including the development of varices
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