Treatment

Whatever type of autoimmune hepatitis you have, the goal of treatment is to slow or stop the immune system attack on your liver. This may help slow the progression of the disease. To meet this goal, you’ll need medications that lower immune-system activity. Treatment with prednisone is generally used initially. A second medication, azathioprine (Azasan, Imuran), may be recommended in addition to prednisone.

Prednisone, especially when taken long term, can cause a wide range of serious side effects, including diabetes, thinning bones (osteoporosis), broken bones (osteonecrosis), high blood pressure, cataracts, glaucoma and weight gain.

Doctors typically prescribe prednisone at a high dose for about the first month of treatment. Then, to reduce the risk of side effects, they gradually reduce the dose over the next several months until reaching the lowest possible dose that controls the disease. Adding azathioprine also helps you avoid prednisone side effects.

Most people need to continue taking the prednisone for at least 18 to 24 months, and many remain on it for life. Although you may experience remission a few years after starting treatment, the disease often returns if the drug is discontinued.

Liver transplant

When medications don't halt the progress of the disease, or you develop irreversible scarring (cirrhosis) or liver failure, the remaining option is a liver transplant.

During a liver transplant, your diseased liver is removed and replaced by a healthy liver from a donor. Liver transplants most often use livers from deceased organ donors. In some cases, a living-donor liver transplant can be used. During a living-donor liver transplant, you receive only a portion of a healthy liver from a living donor. Both livers begin regenerating new cells almost immediately.

Dec. 30, 2015
References
  1. Longo DL, et al., eds. Chronic hepatitis. In: Harrison’s Principles of Internal Medicine. 19th ed. New York, N.Y.: The McGraw-Hill Companies; 2015. http://accessmedicine.com. Accessed Nov. 3, 2015.
  2. Autoimmune hepatitis. National Institute for Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/autoimmunehep/. Accessed Nov. 3, 2015.
  3. Heneghan MA. Autoimmune hepatitis: Pathogenesis. http://www.uptodate.com/index. Accessed Nov. 20, 2015.
  4. AskMayoExpert. Autoimmune hepatitis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
  5. Feldman, M, et al. Autoimmune hepatitis. In: Sleisinger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Oct. 29, 2015.
  6. Corrigan M, et al. Autoimmune hepatitis: An approach to disease
  7. Rajan E (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 21, 2015.
  8. Czaja AJ. Review article: Permanent drug withdrawal is desirable and achievable for autoimmune hepatitis. Alimentary Pharmacology and Therapeutics. 2014;39:1043.