Can Autoimmune Hepatitis go away?
Autoimmune hepatitis is an uncommon chronic immunological disorder occurs when the host immune system produces antibodies against its own liver cells. It is characterized by elevation of aminotransferases and autoantibodies; hypergammaglobulinemia, and interface hepatitis. The accurate cause of this disorder has not been entirely interpreted, but expert believes that genetic circumstantial and environmental factors may contribute to its progression. Previously, it is distinguished as lupoid hepatitis. It affects all ages of all races group in the world and predominantly young women are more prone to this disorder.
Autoimmune hepatitis is classified as type 1 or type 2, according to differences in their autoantibodies. Type 1 presents with antinuclear antibodies and/or anti-smooth muscle antibodies, whereas type 2 is characterized by anti-liver kidney microsome 1. Type 1 disease is the major among in adult and type 2 is most common in children and young people.
Can Autoimmune Hepatitis go away?
With appropriate treatment, most of the patients can attain remission within 18 months. Statistic report says that 80% of the individuals successful recovered within 3 years. After recovering, prescribed medicine must be withdrawn cautiously. In many cases, the patients may relapse (recurrence) after cessation of immunosuppression particularly those with type 2 autoimmune hepatitis (characterized by anti-liver kidney microsome 1) in whom immunosuppression should probably never be stopped. If patients do relapse, retreatment with corticosteroids as per de novo disease is indicated in the first instance followed by lifelong maintenance therapy.
Management of Autoimmune hepatitis
The objective of treatment is to make the disorder to reduce and prevent subsequent difficulties of chronic hepatitis, such as cirrhosis and hepatocellular carcinoma. American Association for the Study of Liver Disease practice guidelines defines remission clinically, biochemically and histologically as the disappearance of symptoms, normalization of transaminases, bilirubin and γ globulin; normal hepatic tissue/inactive cirrhosis.
How to treat Autoimmune hepatitis?
Corticosteroids have been used for more than 40 years to treat autoimmune hepatitis. Prednisolone (steroids) and azathioprine are accepted prescription for autoimmune hepatitis. Standard therapy, as recommended by guidelines, is high-dose steroids (40–60 mg or 1 mg/kg) to induce remission, tapered over time with the addition of azathioprine. Sometimes, mycophenolate can be used as second-line therapy in patients who fails to respond to azathioprine.
There is some evidence for the efficacy of calcineurin inhibitors, including tacrolimus. But, the evidence is not strong for tacrolimus as it is associated with fewer side effects. There are no clinical trial data to support the use of rapamycin or rituximab in autoimmune hepatitis.
Difficulties in the management of autoimmune hepatitis
About 9% of treatment failure cases were observed in patients who have taken steroids and azathioprine. It is common that patients with autoimmune hepatitis present with fulminant hepatic failure. The presence of cirrhosis at the time of starting treatment confers a higher risk of treatment failure. AIH presenting during pregnancy is also challenging to manage. Sometimes, autoimmune hepatitis can coexist with other liver diseases, which does not respond well to immunosuppression.
Some patients may fail to respond to conventional therapy or may be intolerant of standard treatment regimes. A complete failure to respond to initial high-dose corticosteroids is uncommon. Biological therapies are currently coming onto the market which has a potential role in treating several autoimmune diseases. Anticytokine therapies, Rituximab (monoclonal antibody to CD20), TNF blockers, Anti-chemokine therapy, and Modulation of T-cell activation are some of the agents/method successfully involved in treating autoimmune hepatitis.
The majority of patients responds to conventional treatment with corticosteroids and azathioprine and has a good prognosis. With appropriate treatment, most of the patients can attain remission within 18 months. Statistic report says that 80% of the individuals successful recovered within 3 years. New drugs/therapies are promising for patients who fail to respond to conventional therapy or standard treatment regimes.
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