Treatment for Autoimmune Hepatitis

How do doctors treat autoimmune hepatitis?

Doctors treat autoimmune hepatitis with medicines that suppress—or decrease the activity of—your immune system, reducing your immune system’s attack on your liver. The medicines doctors most often prescribe are

• corticosteroids, also called steroids
• immunosuppressants

Doctors typically start with a relatively high dose of corticosteroids and then gradually lower the dose. The medicines used to treat autoimmune hepatitis can cause side effects, so your doctor will try to find the lowest dose that works for you.

Your doctor will use blood tests to check levels of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST). If your ALT and AST levels drop, it means you are responding to the medicines.

Treatment can relieve symptoms and prevent or reverse liver damage in many people with autoimmune hepatitis. Early treatment of autoimmune hepatitis can lower the chances of developing cirrhosis and other complications. A minority of people with autoimmune hepatitis, including some people who have a mild form of the disease or increased risks related to the treatment, may not need medicines.

Remission

With treatment, you may experience remission. Remission is a period when you don’t have any symptoms and your test results show that your liver is working better and is no longer being damaged. Many people with autoimmune hepatitis go into remission. If the first medicines doctors prescribe don’t bring on remission, doctors may prescribe other medicines.

ALT and AST levels falling to normal is a sign of remission. If you are in remission, your doctor may gradually lower the dose of medicines again to help reduce the medicines’ side effects. After you stay in remission for at least 2 years, your doctor may try to stop your medicines to see if you remain in remission without them.⁴

Your doctor will continue to perform routine blood tests for ALT and AST and monitor your symptoms while you are in remission to check for a relapse. Your doctor may suggest a repeat liver biopsy to monitor liver damage and guide management.

Autoimmune hepatitis is often a long-term, if not lifelong, condition. Your doctor will need to watch your condition carefully, particularly when treatment is stopped, because the liver damage may return quickly and may be severe. Stopping treatment without your doctor’s guidance and monitoring may be very dangerous.

Relapse

Some people with autoimmune hepatitis stay in remission without medicines. However, most people relapse after stopping medicines and need to start taking medicines again. When you relapse, blood tests show a rise in ALT and AST levels, and autoimmune hepatitis begins causing symptoms or damaging your liver again.

If you relapse, your doctor will restart or adjust your medicines to treat autoimmune hepatitis.

Incomplete or failed response to treatment

Some people with autoimmune hepatitis have

• an incomplete response to treatment, meaning the treatment helped but did not lead to remission
• a failed response to treatment, meaning the inflammation and liver damage of autoimmune hepatitis keep getting worse despite treatment

If you have an incomplete or failed response to treatment, your doctor may change the medicines you take to treat autoimmune hepatitis. If the disease continues to damage your liver, you may develop complications and need additional treatments.

Do medicines used to treat autoimmune hepatitis have side effects?

Medicines for autoimmune hepatitis can cause side effects. Your doctor will monitor any side effects and help you manage them while you take these medicines. Your doctor also may adjust the doses or change the medicines you take. You may need to stop taking medicines if you have severe side effects.

Doctors treat autoimmune hepatitis with medicines that suppress your immune system.

Side effects of corticosteroids may include

• changes in how you look, which may include weight gain, a fuller face, acne, or more facial hair
• diabetes
• eye problems, such as cataracts or glaucoma
• high blood pressure
• loss of bone density, called osteopenia
• mental health problems, such as extreme changes in mood or psychosis
• pancreatitis

Side effects of azathioprine, an immunosuppressant that many doctors prescribe to treat autoimmune hepatitis, may include

• low white blood cell count
• nausea or vomiting
• skin rash
• liver damage
• pancreatitis

Corticosteroids and immunosuppressants suppress, or decrease the activity of, your immune system, which increases your risk for infections. These medicines can also increase your risk of developing cancers, especially skin cancers.

Before you start taking medicines to treat autoimmune hepatitis, your doctor may

• make sure you have had recommended vaccines, including vaccines for hepatitis A and hepatitis B.
• order tests to check for hepatitis B infection. In people with a current or past hepatitis B infection, medicines used to treat autoimmune hepatitis may cause hepatitis B reactivation. In some cases, doctors may recommend medicines to prevent hepatitis B reactivation.
• order a genetic test for thiopurine S-methyltransferase (TPMT) deficiency. When the TPMT enzyme doesn’t work the way it should, people have a higher risk for serious side effects from certain immunosuppressants.

How do doctors treat the complications of autoimmune hepatitis?

If autoimmune hepatitis leads to cirrhosis, doctors can treat the related health problems and complications with medicines, medical procedures, or surgery.

If you have cirrhosis, you have a greater chance of developing liver cancer. Your doctor may suggest blood tests and an ultrasound or another type of imaging test to check for liver cancer. Finding cancer at an early stage improves the chance of curing the cancer.

If autoimmune hepatitis causes acute liver failure, or if cirrhosis leads to liver cancer or liver failure, you may need a liver transplant.

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