How reversible is hepatic functional impairment in autoimmune hepatitis?

Coverdale, Shirley A; Field, Jacqueline; Farrell, Geoffrey C.

doi:10.1046/j.1440-1746.2003.02981.x

Cited by 8 publications

(8 citation statements)

References 24 publications

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“…The American Association for the Study of Liver Disease (AASLD), in their guidelines, and authorities from King's College Hospital recommend prednisolone at a dose of 40–60 mg/day for induction for 4 weeks and tapered over 6 months, depending on the clinical response. There is good evidence to show that corticosteroids should be continued even after the normalization of serum ALT, because liver histology and metabolic function, as measured by antipyrine clearance, lags behind biochemical parameters by at least 6–12 months 32,33 . Complete drug withdrawal during this period might predispose to relapse.…”

Section: Corticosteroidsmentioning

confidence: 99%

“…There is good evidence to show that corticosteroids should be continued even after the normalization of serum ALT, because liver histology and metabolic function, as measured by antipyrine clearance, lags behind biochemical parameters by at least 6-12 months. 32,33 Complete drug withdrawal during this period might predispose to relapse. The combination of low-dose prednisolone (20-30 mg/ day) with 1 mg/kg azathioprine is advocated by some practitioners to reduce steroid-related side-effects in the induction phase.…”

Section: Corticosteroidsmentioning

confidence: 99%

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Treatment of autoimmune hepatitis: A review of current and evolving therapies

Jothimani

Cramp

Mitchell

et al. 2011

J of Gastro and Hepatol

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Autoimmune hepatitis (AIH) is an immune-mediated necroinflammatory condition of the liver. Presentation can vary from the asymptomatic individual with abnormal liver function test to fulminant liver failure. The diagnosis is based on the combination of biochemical, autoimmune, and histological parameters, and exclusion of other liver diseases. Standard therapy consists of a combination of corticosteroids and azathioprine, which is efficacious in 80% of patients. Alternative therapies are increasingly being explored in patients who do not respond to the standard treatment and/or have unacceptable adverse effects. This review examines the role of alternative drugs (second-line agents) available for AIH treatment non-responders. These agents include budesonide, mycophenolate mofetil, cyclosporin, tacrolimus, 6-mercaptopurine, 6-thioguanine, rituximab, ursodeoxycholic acid, rapamycin, and methotrexate. In addition, the risk of opportunistic infections and malignancies are discussed. A treatment algorithm is proposed for the management of patients with AIH treatment non-responders.

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Section: Corticosteroidsmentioning

confidence: 99%

Section: Corticosteroidsmentioning

confidence: 99%

Treatment of autoimmune hepatitis: A review of current and evolving therapies

Jothimani

Cramp

Mitchell

et al. 2011

J of Gastro and Hepatol

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“…But, as antipyrine is not a CYP3A4/5-specific probe, we used an antipyrine test in this study. The reason was that antipyrine test is a well-established and commonly used test [14][15][16][17]24,25]. In addition, an oral antipyrine test using two data points is a simple and easy method.…”

Section: Discussionmentioning

confidence: 99%

“…Antipyrine is metabolized by several CYP isozymes (CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C18, and CYP3A4) [11], and the antipyrine clearance test is well examined, simple and the most commonly used method for the prediction of CYPs activity [11][12][13][14][15][16][17]. Although antipyrine is not a specific CYP3A4/5 probe, non-specific probes may represent total CYPs activity and may be a general predictor for pharmacodynamics of several combination therapies because not only CYP3A4 but also several CYP isozymes sometimes account for the pharmacodynamics.…”

Section: Introductionmentioning

confidence: 99%

Antipyrine test predicts pharmacodynamics in docetaxel and cisplatin combination chemotherapy

et al. 2005

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“…La recurrencia es CRITERIOS DE REMISIÓN Y RECIDIVA DE LA HAI SEGÚN EL GRUPO INTERNACIONAL PARA LA HEPATITIS AUTOINMUNE Se propone que se monitorizen los cambios en la funcíón metabólica hepática (como mejora en la concentración sérica de albúmina) como parte de la definición de remisión(78).…”

unclassified

Hepatitis autoinmune

Costa¹,

Cabrera²,

Torres³

2004

An. Med. Interna (Madrid)

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Autoimmune hepatitis (AIH) is a hepatocellular inflammation that is characterised by a wide range of histopathologic (periportal interface hepatitis with plasma cell infiltration and piecemeal necrosis), biochemical (hypertransaminasemia, hypergammaglobulinaemia) and autoimmune (several autoantibodies presence) features. This relatively rare disorder frequently affects middle-aged women. There is no pathognomonic marker for AIH diagnosis, therefore it requires a careful rule out of other causes of liver disease together with the detection of a suggestive pattern of clinical and laboratory abnormalities. Scoring system for AIH diagnosis proposed by International Autoimmune Hepatitis Group has been used as a tool in clinical practice but is not sufficiently exclusive in terms of defining prognosis or treatment. AIH has been classified in two subtypes according to autoantibodies detected: 1 and 2, but this classification results in poor clinical implications. Previously known as subtype 3 is at the present included in subtype 1 because no clinical significant differences has been found between them. Aetiology, and molecular mechanisms still remain to be elucitaded in this disease, although viruses, drugs and molecular mimicry act presumably as a trigger in genetically predisposed patients (associated with HLA-DR3 and DR4 haplotypes). On the other hand, immunosuppressive therapy (corticosteroid or azathioprine) generally offers favourable response. Our aim is to review this disease from different points of view, considering: clinical, histopathological, etiologic, genetic, biochemical, autoimmune, treatment and prognosis features.

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How reversible is hepatic functional impairment in autoimmune hepatitis?

Cited by 8 publications

References 24 publications

Treatment of autoimmune hepatitis: A review of current and evolving therapies

Treatment of autoimmune hepatitis: A review of current and evolving therapies

Antipyrine test predicts pharmacodynamics in docetaxel and cisplatin combination chemotherapy

Hepatitis autoinmune

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