Evolution of Therapy in Autoimmune Hepatitis.

Area of Science:

• Hepatology
• Immunology
• Clinical Medicine

Background:

• Autoimmune hepatitis (AIH) is an immune-mediated liver disease with variable clinical presentations.
• Current first-line treatments (corticosteroids, azathioprine) have been standard for 50 years.
• Up to 20% of patients show insufficient response, loss of response, or intolerance to standard therapy.

Purpose of the Study:

• To review the chronological evolution of autoimmune hepatitis treatment.
• To highlight recent advancements and emerging therapies for AIH.

Main Methods:

• Literature review of AIH treatment strategies.
• Analysis of established and novel therapeutic agents.
• Discussion of personalized treatment approaches.

Main Results:

• Established first-line therapies (corticosteroids, azathioprine) remain dominant but have limitations.
• Second-line options include mercaptopurine and mycophenolate mofetil (MMF).
• Advanced strategies involve therapeutic metabolite monitoring, calcineurin inhibitors, and biologics (rituximab, infliximab).

Conclusions:

• AIH treatment is advancing with personalized dosing and novel agents.
• B-cell activating factor blockade shows promise for future AIH management.
• Tailored and evolving therapeutic strategies are crucial for improving patient outcomes.