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—prednisone or prednisolone—with or without another medicine called azathioprine.

Doctors typically start with a relatively high dose of corticosteroids and then gradually lower the dose. Your doctor will try to find the lowest dose that works for you. Your doctor will use blood tests to find out how you are responding to the treatment. A decrease in levels of the liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST) shows a response to treatment. ALT and AST falling to normal levels shows a full response. In some cases, a doctor may repeat a liver biopsy to confirm the response to treatment and find out whether the damage has resolved.

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 who have no symptoms or only a mild form of the disease may or may not need medicines.

Remission

With treatment, you may go into 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.

If you are in remission, your doctor may gradually lower the dose of medicines again and may stop the medicines. 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.

Many people with autoimmune hepatitis go into remission. If people don’t go into remission after taking the medicines discussed above, doctors may prescribe other medicines to try to achieve remission.

Relapse

After a period of remission, you may relapse if your medicines are withdrawn. When you relapse, blood tests show a rise in ALT and AST, and the autoimmune hepatitis begins causing symptoms or damaging your liver again. Most people who have medicines withdrawn during remission relapse. If you relapse, your doctor will restart or adjust your medicines to treat the disease.

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.

Incomplete or failed response to treatment

Some people with autoimmune hepatitis have an incomplete response to treatment, meaning that treatment helps but does not lead to remission. If you have an incomplete response to treatment, you may need to take different medicines to help prevent liver damage.

Some people may fail to respond to treatment, meaning that the inflammation and liver damage of autoimmune hepatitis keep getting worse. Your doctor may recommend additional blood tests and higher doses of medicines. If liver damage leads to complications, you may need treatment for complications.

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 corticosteroids or azathioprine if you have severe side effects.

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 may include

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

Corticosteroids and azathioprine 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.

How do doctors treat the complications of autoimmune hepatitis?

If autoimmune hepatitis leads to cirrhosis, doctors can treat health problems and complications related to cirrhosis with medicines, surgery, and other medical procedures. If you have cirrhosis, you have a greater chance of developing liver cancer. Your doctor may order an ultrasound or other types of imaging tests to check for liver cancer.

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