ABSTRACT
Corticosteroid therapy is effective in all forms of autoimmune hepatitis, and the
combination of prednisone and azathioprine is preferred. Remission can be achieved
in 80% of patients within 3 years, and the 10- and 20-year survival rates exceed 80%.
Histological cirrhosis does not affect response or longevity, and all patients with
severe disease should be treated, including children, elderly adults, postmenopausal
women, individuals with acute or fulminant presentations, and those without conventional
autoantibodies. Relapse is common, and long-term low-dose prednisone or azathioprine
therapy is preferred after multiple relapses. Sustained remission is achievable, even
after relapse, in 47% within 10 years, and the long-term maintenance regimens need
not be indefinite. Liver transplantation is effective, and its actuarial 10-year survival
rate is 75%. Drugs such as cyclosporine, tacrolimus, and mycophenolate mofetil promise
greater blanket immunosuppression, and site-specific interventions are feasible, including
blocking peptides, soluble cytotoxic T lymphocyte antigen-4, cytokine manipulations,
T cell vaccination, oral tolerance, and gene therapy.
KEYWORDS
Corticosteroids - azathioprine - autoimmunity
