Autoimmune Hepatitis Medication

Updated: Sep 25, 2017
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Treatment with corticosteroids and azathioprine is the cornerstone of achieving remission. Initiating azathioprine with prednisone at the beginning of treatment enables a faster decrease in the prednisone dose. Cyclosporine has steroid-sparing effects when administered for several months before corticosteroids and azathioprine.

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Corticosteroids

Class Summary

Rapid institution of treatment with high-dose corticosteroids may rescue patients whose disease ultimately would have progressed to either fulminant hepatic failure or cirrhosis. Treatment with corticosteroids has been shown to improve the chances for survival significantly.

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

Prednisone

Prednisone is an immunosuppressant for the treatment of autoimmune disorders. It may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear neutrophil (PMN) activity. It stabilizes lysosomal membranes and also suppresses lymphocytes and antibody production.

Prednisolone

Prednisolone decreases autoimmune reactions, possibly by suppressing key components of immune system. It may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

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Immunosuppressant agents

Class Summary

These agents inhibit immune reactions resulting from diverse stimuli. Initiating azathioprine with prednisone at the beginning of treatment enables a faster decrease in the prednisone dose. Cyclosporine has steroid-sparing effects when administered for several months before corticosteroids and azathioprine.

Azathioprine (Imuran, Azasan)

Azathioprine antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. It may decrease proliferation of immune cells, which results in lower autoimmune activity.

Cyclosporine (Gengraf, Sandimmune, Neoral)

Cyclosporine is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions (eg, delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, graft versus host disease) for a variety of organs. The dose is based on the ideal body weight.

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