What is your strategy in the management of patients with autoimmune hepatitis who failed azathioprine therapy and what parameters do you monitor with what frequency?

Great question. Around 10% of autoimmune hepatitis cases don't respond to azathioprine (AZA) and 15% may have an incomplete response to AZA. These patients require second-line therapy. Before initiating second-line therapy, it's important to exclude non-adherence. Mycophenolate Mofetil (MMF) is the preferred second therapy. We monitor for clinical and laboratory parameters (liver enzymes, PT/INR, and IgG) every 1-3 months initially. CBC should be monitored for patients on MMF. Other second-line agents are calcineurin inhibitors (tacrolimus). In refractory cases, the only options are biologics or liver transplant.