Treating the Adult Patient: First Line Therapy
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First-line therapy for autoimmune hepatitis (AIH) centers around initiation of predniso(lo)ne followed by the introduction of azathioprine to maintain a biochemical remission. Combination therapy during induction with subsequent tapering of steroids with the intent of maintaining remission with azathioprine monotherapy is the goal. A majority of patients with AIH are capable of attaining a remission with first-line therapy and can be cautiously considered for withdrawal of therapy following 3 years of therapy and after at least 2 years of normal transaminase and IgG levels. Relapse following tapering or after discontinuation of therapy is highly likely, and therefore requires close monitoring and timely resumption of therapy. Individualizing treatment to achieve a balance between maximizing the benefits of therapy while limiting toxicities is the foundation of first-line therapy for AIH.
KeywordsSteroids Prednisone Azathioprine Treatment Management
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