Management of autoimmune hepatitis:Focus on pharmacologic treatments beyond corticosteroids

作     者：Marta Casal Moura Rodrigo Liberal Hélder Cardoso Ana Maria Horta e Vale Guilherme Macedo 

作者机构：Servico de Medicina InternaCentro Hospitalar de Sao JoaoE.P.E.Porto 4200-319Portugal Faculdade de Medicina da Universidade do PortoHernani MonteiroPorto 4200-319Portugal Paediatric Liver Centre and Institute of Liver StudiesKing’s College London School of Medicine at King’s College HospitalLondon SE5 9RSUnited Kingdom Guilherme MacedoServico de GastrenterologiaCentro Hospitalar de Sao JoaoE.P.E.Porto 4202-451Portugal 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2014年第6卷第6期

页      面：410-418页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Autoimmune hepatitis Pharmacologic nonstandard treatment Immunosuppression Azathioprine intolerance Difficult-to-treat patients Salvage therapy 

摘      要：In autoimmune hepatitis, patients who are intolerant or with toxicity experience, non-responders, relapsers or refractory are challenging. Non-standard drugs are being tried to preemptively avoid corticosteroid-related side effects. Prognosis and quality of life of life rely on treatment optimization. Recently, emergence of powerful immunosuppressive agents, mainly from liver transplantation, challenged the supremacy of the corticosteroid regime and promise greater immunosuppression than conventional medications, offer site-specific actions and satisfactory patient tolerance. Successes in experimental models of related diseases have primed these molecular interventions. We performed a literature review on alternative treatments. Azatioprine intolerance is the principal indication for mycophenolate use butit can be used as a front-line therapy. Cyclosporine A and tacrolimus have been tested for non-responders or relapsers. Rituximab may be used as salvage therapy. Anti-tumor necrosis factor-alpha agents may be used for incomplete responses or non-responders. Methotrexate is possibly an alternative for induction of remission and maintenance in refractory patients. Cyclophosphamide has been included in the induction regimen with corticosteroids. Ursodeoxycholic acid action is mainly immunomodulatory. Non-standard treatments are coming slowly to the attention, but its use should be cautious performed by experienced centers.