Approach to maintenance therapy and treatment withdrawal in adults with autoimmune hepatitis

* Refer to the topic on the treatment of autoimmune hepatitis for additional discussion of 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.
¶ Refer to the topic on the treatment of autoimmune hepatitis for detailed instruction on drug administration and tapering. Oral prednisolone is an alternative to prednisone, and oral mercaptopurine is an alternative to azathioprine.
Δ Relapse may be heralded by the development of fatigue, arthralgias, and anorexia, accompanied by a rise in serum aminotransferase levels and/or an increase in serum gamma globulin levels. A rise in serum aminotransferases to more than three times the upper limit of normal or a rise in serum gamma globulins to more than 2 g/dL correlates strongly with the presence of histologic deterioration.
◊ A liver biopsy may help predict which patients are likely to have successful drug withdrawal, but it has not been shown to affect long-term patient outcomes and is not required prior to withdrawing treatment. However, our preference is to obtain a biopsy prior to withdrawing treatment and to continue treatment if there is significant interface hepatitis or other histologic evidence of active disease.