Abstract
The current available evidence for second-line treatments of autoimmune hepatitis is based mostly on small retrospective case series. In patients who are not responding to therapy, it is imperative to ensure that these subjects are being compliant with their medications. In those who cannot tolerate the side effects or are true nonresponders, treatment with alternative medications should be considered. However, it is critical that both provider and patient understand the side effects of the medication, which can be quite severe. Education about these medications, their side effects, and the different treatment options available should be discussed with patients prior to initiating alternative therapy. While results of these studies are promising, with many agents inducing biochemical remission and allowing for weaning of steroids, they are difficult to interpret due to the lack of a common protocol for selection or management of these patients. Randomized control trials (RCT) are needed to compare these medications to the conventional therapy of prednisone and azathioprine.
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Mileti, E., Peters, M. (2012). Strategies for Treatment Nonresponders: Second-Line Therapies and Novel Approaches. In: Hirschfield, G., Heathcote, E. (eds) Autoimmune Hepatitis. Clinical Gastroenterology. Springer, New York, NY. https://doi.org/10.1007/978-1-60761-569-9_8
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