title: Pharmacological management of autoimmune hepatitis.
abstract: BACKGROUND
  Without prompt immunosuppressive treatment, autoimmune hepatitis is a devastating, albeit rare, liver disease. It affects both adults and children, being particularly aggressive in the latter. Eighty per cent of patients respond satisfactorily to treatment; the other 20% progress to end-stage liver disease and require transplantation.
  
  
  METHODS
  This review emphasizes the importance of a timely diagnosis of autoimmune hepatitis and provides a practical guide for its treatment. The authors summarize the treatment options available for autoimmune hepatitis and stress that most patients respond successfully to standard treatment with prednisolone and azathioprine, two well-tried and inexpensive drugs. The authors also review the options for difficult-to-treat patients (non-responders and frequent relapsers), for whom newer immunosuppressive agents--usually employed as anti-rejection drugs--have been tried with variable success.
  
  
  CONCLUSIONS
  Autoimmune hepatitis is exquisitely responsive to immunosuppression but treatment must be started as soon as possible to achieve full remission and halt progression of liver disease. New strategies aiming at treating the unresponsive patients and at specifically curbing the liver autoimmune attack, without provoking unwanted systemic side effects, are being investigated and may be available within the next 5 years.
authors.affiliation: Institute of Liver Studies, King's College London School of Medicine at King's College Hospital, Denmark Hill, London, UK. diego.vergani@kcl.ac.uk
authors.forename: Diego
authors.initials: D
authors.lastname: Vergani
authors.forename: Giorgina
authors.initials: G
authors.lastname: Mieli-Vergani
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000209:etiology* / Q000628:therapy; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016031:Liver Transplantation; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D011239:Prednisolone; D001379:Azathioprine