Hepatitis - Autoimmune Hepatitis

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Side effects can be very distressing and sometimes serious. They include weight gain, skin problems, moon-shaped face, high blood pressure, diabetes, cataracts, mental disturbances, infections, and osteoporosis.

Investigational Drugs. In severe cases, drugs that block the immune system may be used:

• Azathioprine (Imuran) is often prescribed along with steroids to help reduce severe side effects caused by using steroids alone. Azathioprine also suppresses the immune system and helps prevent relapse, but the drug will not induce remission by itself. In one promising study, patients who continued to use azathioprine after prednisolone was withdrawn had no relapses for at least a year. Unfortunately, long-term use of azathioprine may increase the risk for cancer, although studies indicate that this risk is very low.
• Cyclosporine A (Neoral) is another immunosuppressant and may prove to be a safe and effective alternative to corticosteroids.

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Some research is targeting drugs that inhibit RNA -- the genetic molecules that serve as messengers for regulating cellular processes.

Liver Transplantation and Autoimmune Hepatitis. If all therapies fail and the disease becomes life-threatening, liver transplantation may be performed. Liver transplantation is problematic, however. In one study, half of patients who received a transplant required re-transplantation within a year. Autoimmune hepatitis recurred in 25% of patients studied. (According to a 2000 study, transplantation in these patients may improve accompanying autoimmune disorders.) Children who develop autoimmune hepatitis after liver transplantation may respond to corticosteroid and azathioprine therapy.

Review Date: 08/17/2006
Reviewed By: Harvey Simon, MD, Editor-in-Chief, In-Depth Reports; Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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