Autoimmune hepatitis: management of complex cases.

Abstract

Autoimmune hepatitis (AIH) is a chronic immune-mediated inflammatory liver disease that may progress to cirrhosis, hepatic decompensation, and liver transplantation if not adequately controlled[1],[2]. Although standard therapy with corticosteroids and azathioprine (AZA) induces remission in the majority of patients, approximately 10–30% develop complex disease courses characterized by treatment intolerance, insufficient response, or severe acute presentations[1],[3]. The primary therapeutic goal is to achieve complete biochemical response (CBR), defined as normalization of serum transaminases and immunoglobulin G (IgG) levels, ideally within 6 months[4]. This review addresses the management of refractory AIH, the use of second- and third-line therapies, and specific considerations in special populations, including pregnant women and patients with decompensated cirrhosis or metabolic dysfunction–associated steatotic liver disease (MASLD).

Keywords: autoimmune hepatitis, complete biochemical response, refractory disease, second- and third-line therapy, mycophenolate mofetil, complex cases.