[Synthetic glucocorticoid therapy in liver diseases]

Glucocorticoids are used in patients with liver diseases in the following cases: The major indication for glucocorticoids in liver disease is autoimmune hepatitis (AIH). Although prednisone at 30 to 60 mg/day is widely used throughout the world, the usual starting dose in Japan is 15 to 20 mg/day with the maintenance dose adequate at 5 to 10 mg/day since AIH in Japan is usually mild with few severe cases and since the weight of Japanese patients is generally lighter. Another indication is in chronic hepatitis B as corticosteroid withdrawal therapy. Prednisone at 30 to 40 mg/day is administered for three weeks and then withdrawn. If the administration of prednisone increases the level of HBV, the withdrawal of prednisone elevates GPT and reduces HBV. Other indications include primary biliary cirrhosis and fulminant hepatitis but only in limited situations.