Treatment challenges and investigational opportunities in autoimmune hepatitis.
New drugs and advances in molecular biology afford opportunities to upgrade the treatment of autoimmune hepatitis. The aims of this study were to define treatment problems, identify possible solutions, and stimulate investigations to improve patient care. A clinical subcommittee of the International Autoimmune Hepatitis Group reviewed current management difficulties and proposed corrective actions. The assessment of new front-line and salvage therapies for adults and children were given top priority. Cyclosporine and mycophenolate mofetil were endorsed as drugs worthy of rigorous study in severe disease, and budesonide was endorsed for study as front-line therapy in mild disease. Diagnostic criteria and treatment regimens for children required codification, and pharmacokinetic studies were encouraged to develop optimal dosing schedules based on therapeutic ranges. Collaborative efforts were proposed to help understand racial, geographical, and genetic factors affecting outcome and to establish definitions and therapies for variant syndromes and graft dysfunction after transplantation. The development of experimental animal models was deemed essential for the study of site-specific molecular interventions, and gene therapy was endorsed as a means of bolstering reparative processes. In conclusion, evolving pharmacological and technical advances promise to improve the treatment of autoimmune hepatitis, and investigations of these advances are timely, feasible, and necessary.
Czaja
Albert J
AJ
Mayo Clinic College of Medicine, Division of Gastroenterology and Hepatology, Rochester, MN 55905, USA. czaja.albert@mayo.edu
Bianchi
Francesco B
FB
Carpenter
Herschel A
HA
Krawitt
Edward L
EL
Lohse
Ansgar W
AW
Manns
Michael P
MP
McFarlane
Ian G
IG
Mieli-Vergani
Giorgina
G
Toda
Gotaro
G
Vergani
Diego
D
Vierling
John
J
Zeniya
Mikio
M
D005762:Gastroenterology / Q000639:trends*; D019693:Hepatitis, Autoimmune / Q000628:therapy*; D006801:Humans