The use of immunosuppression in autoimmune hepatitis: A current literature review

Abstract

Autoimmune hepatitis (AIH) is an organ specific autoimmune condition which can manifest at any age of life. The heterogeneous nature of this condition means that great variation can be seen in severity, progression of disease and response to treatment within this patient group. Since the 1980s prednisolone and azathioprine have been used for induction and remission of the disease and remain the mainstay of treatment. Other immunosuppressive agents have been employed in difficult to treat cases. While there is less published data regarding these agents compared with the conventional treatments of steroid and azathioprine, there is mounting evidence to support the use of mycophenolate mofetil as a second-line agent. The calcineurin inhibitors, though less studied, additionally show promise. More data is needed on the use of biological agents in refractory disease. This review focuses on our centre’s approach to treatment of AIH in the context of a contemporary review of the literature.

Transient elastography to assess liver stiffness in patients with inflammatory bowel disease

“…Furthermore, in patients with inflammatory disorders of the liver, such as auto-immune hepatitis, AZA is used to diminish inflammation. Interestingly, AZA might have an anti-inflammatory effect on the liver itself, probably accounting for less hepatic damage [40].…”

Thrombotic thrombocytopenic purpura and defective apoptosis due to CASP8/10 mutations: the role of mycophenolate mofetil

“…Regarding the response to treatment, MMF, on account of the inhibition of B, T, and natural killer cells, has been shown to be effective in autoimmune cytopenia and in a number of other autoimmune diseases. [22][23][24] In this patient, MMF seemed to have had a certain efficacy in the maintenance of autoimmunity suppression against ADAMTS13 with no undesirable effects. Moreover, according to a recent article, persistent low ADAMTS13 activity, as observed in our patient, seems to be a predictor of relapse and thus indicates a possible role for a preemptive immunosuppression regimen.…”

Rheumatic Manifestations in Autoimmune Liver Disease

“…It should be noted, however, that subgroups of patients manifest disease progression (approximately 10%) or are intolerant to standard therapy (13%). In such patients, other drugs have been anecdotally tried, including methotrexate 55 , cyclophosphamide, tacrolimus, ursodeoxycholic acid, cyclosporine and mycophenolate mofetil, the latter two constituting the most frequently reported alternatives 18,56 . Biologic therapies commonly used in rheumatology are of particular interest, as pro-inflammatory cytokines, i.e.…”

“…Biologic therapies commonly used in rheumatology are of particular interest, as pro-inflammatory cytokines, i.e. tumor necrosis factor (TNF)-alpha, are involved in AIH pathogenesis 18 . Infliximab has been used in refractory cases of AIH with reduction of aminotransferases and IgG levels 57 .…”