title: Current and prospective pharmacotherapy for autoimmune hepatitis.
abstract: BACKGROUND
  Corticosteroids alone or in combination with azathioprine are the mainstay therapies of autoimmune hepatitis. Suboptimal responses (treatment failure, partial response, drug toxicity), frequent relapse after drug withdrawal, and the emergence of alternative immunosuppressive medications have fueled the pursuit of new treatments. The goals of this review are to present current management strategies and evolving interventions.
  
  
  METHODS
  PubMed searches from 1970 - 2014 provide the bases for this review. Corticosteroid regimens should be administered until resolution of symptoms, laboratory tests, and liver tissue abnormalities. Treatment failure warrants high doses of the original regimen, and relapse warrants re-treatment followed by long-term maintenance with azathioprine. The calcineurin inhibitors, budesonide, and mycophenolate mofetil are evolving as frontline therapies, and they may be considered as salvage therapies with the exception of budesonide. Rapamycin, rituximab, and infliximab have also rescued refractory patients but experiences are limited. Anti-oxidants, recombinant molecules, mAbs, and modulators of critical cell populations are key prospects.
  
  
  CONCLUSIONS
  Autoimmune hepatitis must be managed by multiple medications that supplement or supplant current regimens depending on the clinical situation. Rescue therapies will emerge as adjunctive interventions to minimize tissue damage (prevent fibrosis and hepatocyte apoptosis) and improve immune tolerance (regulatory T cell manipulations).
authors: Mayo Clinic College of Medicine, From the Division of Gastroenterology and Hepatology , 200 First Street S.W, Rochester, MN 55905 , USA +1 507 284 2691 ; +1 507 284 0538 ; czaja.albert@mayo.edu.
authors: Albert J
authors: AJ
authors: Czaja
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000818:Animals; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D000069283:Rituximab; D016879:Salvage Therapy; D020123:Sirolimus / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D019819:Budesonide; D009173:Mycophenolic Acid; D001379:Azathioprine; D020123:Sirolimus
keywords: autoimmune hepatitis; immunosuppressive drugs; mAbs; recombinant molecules; treatments