Autoimmune hepatitis azathioprine

Several types of immunosuppression have also been tried. Azathioprine alone was found to have no effect on PBC [82], but additional benificial effects were found in combination with ursodeoxychohc add and corticosteroids [78]. Cyclosporin showed some success, espe-dally in corticosteroid-resistant autoimmune hepatitis [83], but its use is generally considerably hmited by severe side-effects. Corticosteroids were effective in the management of several types of autoimmune chronic active hepatitis [84,85] and in the management of acute al-cohohc hepatitis [86]. Their use, however, has to be brief hi order to minimize side-effects. In the treatment of PBC, corticosteroids alone were found to be toxic and had only limited efficacy [77]. 

A patient developed atorvastatin-induced severe autoimmune hepatitis and a lupus-like syndrome. Although the drug was immediately withdrawn, the disease persisted and deteriorated to a fulminant form with acute hepatic failure. There was no response to conventional immunosuppression with glucocorticoids and azathioprine. Only the introduction of intense immunosuppressive therapy, as used in solid organ transplantation, led to a complete and sustained recovery. The patient had the HLA haplotypcs DR3 and DR4, which are well-known genetic factors associated with autoimmune diseases. 

Autoimmune hepatitis If single drug therapy then start with 60 mg p.o. q.d. and taper over 4 weeks to 20 mg q.d. maintenance dose until end point. If combination therapy with azathioprine, then start with 30 mg q.d. and taper over 4 weeks to 10 mg q.d. maintenance dose until endpoint... 

Autoimmune hepatitis typically occurs in females, at puberty and between the ages of 40 and 70. It can also occur in males at any age. It may present in a number of ways as a mild hepatitis, as a severe acute hepatitis or as established cirrhosis. The functioning capacity of the liver will vary depending on the stage of disease. The diagnosis of AIH is based on serum biochemistry, liver histology, and the presence of certain autoantibodies in the serum. Exclusion of other potential causes of hepatitis, e.g. hepatitis B or C, alcohol consumption, is needed before a definitive diagnosis can be made. There are no featnres that are specifically indicative of AIH, but it usually responds to treatment with corticosteroids. Once remission is indnced azathioprine or... 

A female patient between 35 and 40 years of age with confirmed (in line with the methods of the time, including laparoscopy and biopsy) autoimmune hepatitis (ANA ++, SMA+, LMA +, LE factor+, IgG++, y-globulin++, GPT, GOT80-100 Utl, GDH ca. 12 UH, no cholestasis) had been undergoing treatment with prednisolone I azathioprine and had been in constant remission for over 3 years (maintenance dose of 4—6 mg prednisolone and 50 mg azathioprine for over 2 years). Physically and mentally stable, engaged in her profession, she had placed great confidence in us. Approximately 3 days after a sudden, severe emotional trauma with mental breakdown, the AlH deteriorated on a massive scale, and about 3 weeks later, the patient died in a coma hepaticum from acute liver failure. 

Johnson, P.J., McFarlane, I.G., Williams, R. Azathioprine for longterm maintenance of remission in autoimmune hepatitis. New Engl. J. 72... 

Rerson, J.L., McHutchison, J.G., Fong, T., Redeker, A.G. A case of cyclosporine-sensitive, steroid-resistant autoimmune chronic active hepatitis. J. Clin. Gastroent. 1993 17 317-320 Rratt, D.S., Flavin, D.R., Kaplan, M.M. The successful treatment of autoimmune hepatitis with 6-mercaptopurine after failure with azathioprine. Gastroenterology 1996 110 271-274 Rahaman, SM., Chira, R, Koff, R.S. Idiopathic autoimmune chronic hepatitis triggered by hepatitis A. Amer. J. Gastroent. 1994 89 106-108... 

Pratt, D.S., Flavin, D.P., Kaplan, MM. The successful treatment of autoimmune hepatitis with 6-mercaptopurine after failure with azathioprine. Gastroenterology 1996 110 271-274... 

Perreaux F, Zenaty D, Capron F, Trioche P, Odievre M, Labrune P. Azathioprine-induced lung toxicity and efficacy of cyclosporin A in a young girl with type 2 autoimmune hepatitis. J Pediatr Gastroenterol Nutr 2000 31(2) 190-2. 

A 7-year-old boy with Duchenne muscular dystrophy and attention deficit hyperactivity disorder (ADHD) developed acute hepatic failure, with features of autoimmune hepatitis (2). The only medications he had taken were pemoline (56 mg/day) and cjrproheptadine (2 mg/day). Pemoline was withdrawn after 8 months as the presumed cause of his raised transaminases. Two weeks later he developed an altered mental state, jaundice, and encephalopathy. The histological features of the liver and his autoimmune antibody panel were consistent with autoimmune hepatitis. He was treated with corticosteroids and azathioprine and recovered. 

Mulder CJ. Promising treatment of autoimmune hepatitis with 6-thioguanine after adverse events on azathioprine. Eur J Gastroenterol Hepatol 2005 17(4) 457-61. 

Dhaliwal HK, Anderson R, ThornhiU EL, Schneider S, McFarlane E, Gleeson D, et al. Clinical significance of azathioprine metabolites for the maintenance of remission in autoimmune hepatitis. Hepatology October 2012 56(4) 1401-8. PubMed PMID 22488741. Epub 2012/04/11. eng. 

Corticosteroids, often given in conjunction with azathioprin, improve hepatic function and may reduce the risk of advancing autoimmune disease-associated cirrhosis. 

Bellary, S., Schlano, T., Hartman, G., Black, M. Chronic hepatitis with combined features of autoimmune chronic hepatitis and chronic hepatitis C favorable response to prednisone and azathioprine. Ann. Intern. Med. 1995 123 32-34... 

R. Maintenance of remission in autoimmune chronic active hepatitis with azathioprine after corticosteroid withdrawal. Hepatology 1988 8 781-784... 

Although azathioprine-associated pulmonary toxicity mostly occurs as part of the azathioprine hjq)ersensitivity reaction, isolated interstitial pneumonitis has been reported in a 13-year-old girl with autoimmune chronic active hepatitis (9). 

Autoimmune chronic hepatitis is usually associated with amenorrhea, but pregnancy may occur after treatment to remission with corticosteroids. The steroids should be continued during the pregnancy. Pregnancy should be avoided in patients being treated with azathioprine. 

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