Autoimmune hepatitis:Towards a personalized treatment  

作　　者：Alejandro Costaguta Guillermo Costaguta FernandoÁlvarez 

机构地区：[1]Department of Hepatology and Liver Transplant Unit,Sanatorio de Niños de Rosario,Rosario 2000,Santa Fe,Argentina [2]Department of Gastroenterology,Hepatology,and Nutrition,CHU Sainte-Justine,Montreal H3T 1C5,Quebec,Canada [3]of Pediatrics,CHU Sainte-Justine,Montreal H3T 1C5,Quebec,Canada

出　　处：《World Journal of Hepatology》2024年第11期1225-1242,共18页世界肝病学杂志（英文）

摘　　要：Autoimmune hepatitis is an uncommon condition that affects both adults and children and is characterized by chronic and recurrent inflammatory activity in the liver.This inflammation is accompanied by elevated IgG and autoantibody levels.Historically,treatment consists of steroids with the addition of azathioprine,which results in remission in approximately 80%of patients.Despite significant advancements in our understanding of the immune system over the past two decades,few modifications have been made to treatment algorithms,which have remained largely unchanged since they were first proposed more than 40 years ago.This review summarized the various treatment options currently available as well as our experiences using them.Although steroids are the standard treatment for induction therapy,other medications may be considered.Cyclosporin A,a calcineurin inhibitor that decreases T cell activation,has proven effective for induction of remission,but its long-term side effects limit its appeal for maintenance.Tacrolimus,a drug belonging to the same family,has been used in patients with refractory diseases with fewer side effects.Sirolimus and everolimus have interesting effects on regulatory T cell populations and may become viable options in the future.Mycophenolate mofetil is not effective for induction but is a valid alternative for patients who are intolerant to azathioprine.B celldepleting drugs,such as rituximab and belimumab,have been successfully used in refractory cases and are useful in both the short and long term.Other promising treatments include anti-tumor necrosis factors,Janus kinases inhibitors,and chimeric antigen receptor T cell therapy.This growing armamentarium allows us to imagine a more tailored approach to the treatment of autoimmune hepatitis in the near future.

关 键 词：Novel therapies Immunosuppressors Treatment tailoring PERSONALIZATION Special populations 

分 类 号：R575.1[医药卫生—消化系统]