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What patient factors guide your selection of maintenance therapies for a patient with autoimmune hepatitis?

1 Answer
Mednet MemberInvited Expert
Hepatology · Northwestern
Answered on · Updated on

I have no deep insight here. The goal is to try to get labs as normal as possible - also realizing that once achieved normal labs do not per se imply normal liver. Histological control lags biochemical control by years, hence the need for prolonged therapy and biopsies prior to withdrawal of therapies if appropriate. Thence achieving clinical, biochemical and histological remission; similar to goals of IBD in that regard. Standard maintenance can be prednisone with staggered addition of azathioprine to a 1+mg/kg goal. If not tolerating Pred, and not cirrhotic, consider budesonide. if not tolerating azathioprine consider mycophenolate. Obvious clinical tolerability of steroids, particularly glucose control, and aza/myco, particularly GI side...

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