Autoimmune hepatitis

The standard treatment is the combination of predniso(lo)n and azathioprine. Combination therapy has the advantage that the dose of glucocorticoids can be lower. Fewer side effects from these drugs also improve patient compliance. After one year of combination therapy, azathioprine alone may be sufficient to maintain remission.

For patients who do not respond to predniso(lo)n, budesonide is an alternative. It has the advantage of lower systemic glucocorticoid levels and thus fewer side effects due to a high hepatic first-pass effect. Its use can also be considered for maintenance therapy if there is a particular risk of steroid-related side effects. However, the prerequisite for administration is that the patient does not yet have cirrhosis.

People with AIH have to be prepared for long-term, usually permanent, pharmacotherapy. Only a few patients are able to stop taking the medication completely; in most cases, the inflammation flares up again. For long-term steroid therapy, the authors of the guideline recommend concomitant osteoporosis prophylaxis. Azathioprine can lead to blood count changes, and potential hepatotoxicity should also be considered. During regular check-ups, the doctor looks at the course of the disease in order to be able to intervene early in case of deterioration. With timely diagnosis and consistent treatment, the long-term prognosis for patients is good and they can expect an almost normal life expectancy.

However, some patients do not respond to the standard therapy. In these cases, the doctor may test other, less well-tested drugs from transplant medicine that are not approved for this indication, such as ciclosporin, tacrolimus or mycofenolate mofetil. If therapy fails completely, liver failure is imminent and organ transplantation is the last therapeutic option.