Hepatitis - Autoimmune Hepatitis

Treatments for Autoimmune Hepatitis

Autoimmune Hepatitis. Patients with autoimmune hepatitis who have mild symptoms and slight inflammation of the liver do not require any treatment except to alleviate symptoms. They should be monitored, however, for any signs of disease progression. Severe autoimmune hepatitis is a life-threatening condition and requires intensive therapy.

text continues below

Patients with autoimmune hepatitis who have mild symptoms and slight inflammation of the liver do not require any treatment except to alleviate symptoms. They should be monitored, however, for any signs of disease progression. Because of effective treatment options and in spite of a high rate of relapse, long-term survival rates in patients with autoimmune hepatitis are excellent. Drugs that block factors in the immune system and help reduce inflammation and symptoms of autoimmune hepatitis are most often used.

Corticosteroids. Corticosteroids, prednisone and prednisolone, are the standard agents used for autoimmune hepatitis. They produce remission of symptoms in about 80% of patients with autoimmune hepatitis. For most patients, steroids also reduce symptoms within three months, improve liver function within six months, and restore liver health within two years. Between 10% and 20% of patients continue to deteriorate despite steroid treatment, although higher doses may help some of these people. (Steroids are generally not useful for chronic hepatitis B or C, and, in fact, suppressing the immune system in these patients can encourage the viruses to replicate more quickly.)

Treatment usually needs to continue for about two years before the disease is in complete remission. Usually, steroids are stopped when disease symptoms have disappeared, when blood tests show that aminotransferase levels are less than two times normal, and liver biopsies reveal no active cell damage. Steroid medications must be withdrawn very slowly. Patients who are very elderly or who have advanced (decompensated) cirrhosis are not good candidates for this treatment.

Unfortunately, remission rarely lasts more than three years. About half of patients relapse within six months, and only about 20% of patients achieve remission (are disease-free) for more than five years. Re-administering prednisone therapy after relapse achieves another remission in 80% of patients.

Side effects can be very distressing and sometimes serious; they include weight gain, skin problems, moon-shaped face, high blood pressure, diabetes, cataracts, mental disturbances, infections, and osteoporosis.