2020 Webinar: Treatment Strategies for Autoimmune Hepatitis Beyond First-line Therapy-Treatment Strategies for Autoimmune Hepatitis Beyond First-line Therapy

Video Transcription

Video Summary

The study compared the effectiveness of two second-line therapies, MMF and tacrolimus, in patients with AIH who didn't respond to first-line treatment. Both MMF and tacrolimus were found to be effective in maintaining a high rate of biochemical response in patients intolerant to first-line therapy. However, when it came to non-responders, tacrolimus was found to be superior in achieving a complete response compared to MMF. During the maintenance phase of therapy, a significant proportion of patients were able to withdraw steroids while on either MMF or tacrolimus. The study concluded that tacrolimus may be a better second-line therapy for non-responders compared to MMF.<br /><br />The use of calcineurin inhibitors, such as tacrolimus and cyclosporine, as second-line therapies for AIH was discussed. The optimal trough levels for these medications are not well-established, but generally lower doses are required compared to use in transplantation patients. The use of allopurinol to enhance the efficacy of azathioprine was mentioned, but specific dosing guidelines are lacking. The continuation of low-dose prednisone in patients on azathioprine maintenance therapy was also discussed, with emphasis on individualized treatment plans. The use of rituximab as a third-line therapy was mentioned but requires further research to determine its optimal use. The study also highlighted the need for individualized treatment plans in AIH patients, considering comorbid conditions and the side effect profiles of different medications. Overall, the study underscored the importance of further research to establish dosing guidelines and determine the best treatment strategies for AIH patients.

Asset Caption

Moderator: John M. Vierling, MD, FACP, AGAF, FAASLD
Presenters: Aparna Goel, MD and Therese Bittermann, MD

Keywords

second-line therapies

MMF

tacrolimus

AIH

biochemical response

non-responders

complete response

steroid withdrawal

dosing guidelines

individualized treatment plans