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Treatments and drugs
By Mayo Clinic staff
Whatever type of autoimmune hepatitis you have, the goal of treatment is to slow or stop your body's immune system from attacking your liver. This may help slow the progression of the disease.
Medications to control your immune system (immunosuppressants)
Medications used to treat autoimmune hepatitis include:
-
Prednisone. Doctors usually recommend an initial high dose of the corticosteroid drug prednisone for people with autoimmune hepatitis. The medication is reduced to the lowest possible dose that controls the disease over a few weeks. Most people need to continue taking the prednisone for at least 18 to 24 months, and some people 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.
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.
- Azathioprine (Azasan, Imuran). Azathioprine, another immunosuppressant medication, is sometimes used along with prednisone. Using both medications may allow you to take a smaller dose of prednisone, reducing its side effects. Side effects of azathioprine may include difficulty fighting infections and nausea. Rare side effects include liver damage, pancreas inflammation (pancreatitis) and cancer.
- Other immunosuppressants. If you don't respond to prednisone or azathioprine, your doctor may prescribe stronger immunosuppressants, such as mycophenolate (CellCept), cyclosporine (Neoral, Sandimmune, others) or tacrolimus (Prograf).
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.
- Czaja AJ, et al. Advances in the diagnosis, pathogenesis, and management of autoimmune hepatitis. Gastroenterology. 2010;139:58.
- Krawitt EL. Pathogenesis of autoimmune hepatitis. http://www.uptodate.com/index. Accessed Feb. 9, 2012.
- Manns MP, et al. Diagnosis and management of autoimmune hepatitis. Hepatology. 2010;51:1.
- Autoimmune hepatitis. National Institute for Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/autoimmunehep/. Accessed Feb. 9, 2012.
- McPhee SJ, et al. Current Medical Diagnosis & Treatment 2012. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=1. Accessed Feb. 16, 2012.
- Luxon BA. Diagnosis and treatment of autoimmune hepatitis. Gastroenterology Clinics of North America. 2008;37:461.
- Mieli-Vergani G, et al. Autoimmune hepatitis. Nature Reviews. Gastroenterology and Hepatology. 2011;8:320.
- Greenberger NJ, et al, eds. Current Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy. New York, N.Y.: McGraw-Hill; 2009. http://www.accessmedicine.com/content.aspx?aID=6204532. Accessed Feb. 16, 2012.
- Teufel A, et al. Concurrent autoimmune diseases in patients with autoimmune hepatitis. Journal of Clinical Gastroenterology. 2010;44:208.
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