How is AIH treated?
The goals of treatment are to quickly reduce the inflammation in the liver by suppressing the immune system in order to stop and prevent further liver damage. Ongoing active inflammation causes liver cell injury and death as well as activation of a liver healing mechanism, also known as fibrosis. Controlling inflammation is thought to prevent liver disease progression, and in most patients, allows the liver to regenerate new healthy cells. It may even help to reverse more advanced fibrosis in some patients with time. Treatment typically begins with a fast acting steroid such as Prednisone/Prednisolone or Budesonide at a high dosage. As symptoms improve and once the liver enzymes start to approach normal levels, the steroid is reduced and a second medication is usually added - an immunomodulator such as Azathioprine. Treatment approaches vary across practitioners and even continents, however the goal is the same. The addition of the immunomodulator allows the steroid to be reduced to a very low dosage or eliminated to prevent potential adverse side effects of chronic steroid use. Most experts believe that most patients will require lifetime treatment, however, some patients have been successfully weaned off of treatment medications over time. However, autoimmune hepatitis is considered a chronic illness - one that must be monitored closely, commonly for life. Most patients respond well to immunosuppressant medications (steroids and immunomodulators), however a small number may not respond adequately to standard treatments or liver damage at the time of diagnosis may be so severe that consideration of liver transplant is necessary.