Challenges in the use of corticosteroids in the management of autoimmune hepatitis

Abstract

Autoimmune hepatitis is widely assumed by health-care professionals to be a disease that is easily controlled through the use of corticosteroids and immunosuppressants but recent studies in the UK indicate highly variable treatment regimens and often unsatisfactory treatment outcomes, such as dependence on long-term high-dose steroids and ongoing need for liver transplantation in some cases. The therapeutic use of the systemically acting corticosteroid prednisolone results in unacceptable side effects in many patients. Recent evidence suggests that it is not always necessary to use high-dose steroids (>0.5 mg/kg/d) to attain remission; and side effects may also be minimised through more targeted therapy with the less systemically-absorbed corticosteroid, budesonide. The authors offer advice on the stratification of treatment for these patients and suggest changes to improve the services available for people with autoimmune hepatitis in the UK.

Corticosteroids for high‐grade immune checkpoint inhibitor–mediated hepatitis: Is less more?

“…Clinicians prefer to limit the use of high‐dose steroids because of potentially higher rates of infection, hyperglycemia, low bone density, and uncertain effects on malignancy outcomes. [ 3,4 ]…”

“…Clinicians prefer to limit the use of high-dose steroids because of potentially higher rates of infection, hyperglycemia, low bone density, and uncertain effects on malignancy outcomes. [3,4] A retrospective cohort study by Li et al provides much-needed data to inform the management of grade 3-4 IMH, including corticosteroid dosing, benefits of dose escalation, and frequency of adverse outcomes. [5] They analyzed a large patient cohort who developed grade 3-4 IMH after receiving one or more ICIs between 2010 and 2020.…”

Fecal Microbiota Transplantation Controls Progression of Experimental Autoimmune Hepatitis in Mice by Modulating the TFR/TFH Immune Imbalance and Intestinal Microbiota Composition

“…Corticosteroids and immunosuppressants are the main therapeutic methods for alleviating symptoms and prolonging life in AIH patients ( 15 ). Although the efficacy of these therapy are satisfactory in most patients, 10%–20% of cases with AIH still progress to end-stage liver disease and require liver transplantation ( 16 ).…”