Approach to induction therapy for adults with autoimmune hepatitis

* Refer to the topic on the treatment of autoimmune hepatitis for additional discussion of the indications for treatment and for details on the treatment of special populations including patients with fulminant hepatitis, children, women who are pregnant, patients with cirrhosis, patients with hepatitis C virus, and patients with variants of autoimmune hepatitis.
¶ Asymptomatic patient with aminotransferase levels <10 times the upper limit of normal.
Δ Refer to topic on the treatment of autoimmune hepatitis for detailed instruction on drug administration. Oral prednisolone is an alternative to prednisone. Budesonide may also be an alternative to prednisone, particularly for patients at increased risk for glucocorticoid side effects. Oral mercaptopurine is an alternative to azathioprine.
◊ Eg, brittle diabetes, osteoporosis, emotional lability, history of psychosis, poorly controlled hypertension.
§ In Europe, initial therapy is often with prednisone/prednisolone and oral azathioprine. If this treatment is chosen, go to Box A.
¥ Refer to the UpToDate topic on the treatment of patients with autoimmune hepatitis for details.