Management of Autoimmune Hepatitis Patients Refractory to or Intolerant of Standard Therapies

Abstract

Autoimmune hepatitis is a progressive T cell-dependent inflammatory process characterized by elevated autoantibodies, serum globulins, and interface hepatitis. Pharmacologic treatment focuses on achievement of complete biochemical remission. The goal of this paper is to describe the unique features that guide treatment in difficult-to-control cases of autoimmune hepatitis. Recently published retrospective reviews have noted the efficacy of multiple second- and third-line agents in the treatment of autoimmune hepatitis. There has been no widely accepted approach regarding which agents to use in specific patient populations. This paper attempts to summarize recent evidence regarding treatment efficacy of second- and third-line therapies and addresses patient-specific considerations when deciding which therapies to choose.