How Is Autoimmune Hepatitis Treated?

Bozz District

Hepatitis is an inflammatory condition that can develop with or without a viral infection. In the case of autoimmune hepatitis, the body’s immune system mistakenly attacks healthy liver cells. This can lead to cirrhosis or even liver failure if the condition isn’t treated effectively. Treatment options for autoimmune hepatitis include […]

Hepatitis is an inflammatory condition that can develop with or without a viral infection. In the case of autoimmune hepatitis, the body’s immune system mistakenly attacks healthy liver cells. This can lead to cirrhosis or even liver failure if the condition isn’t treated effectively.

Treatment options for autoimmune hepatitis include corticosteroids and other immunosuppressant medications, as well as a lifestyle that promotes healthy liver function. With early and appropriate treatment, autoimmune hepatitis can often be controlled.

Hepatitis refers to any of several inflammatory conditions affecting the liver. For example, there are five different types of viral hepatitis: A, B, C, D, and E. Toxins, such as alcohol or various drugs, may also cause hepatitis.

Autoimmune hepatitis is less common, with the National Organization for Rare Disorders reporting about 1 to 2 new cases per 100,000 people each year. Women and people with other autoimmune disorders are much more likely to develop autoimmune hepatitis than men or individuals without any autoimmune conditions.

While the cause is not completely understood by the medical community, researchers suggest that the following three key factors may be at the root of autoimmune hepatitis:

  • genetic predisposition (having inherited a gene mutation responsible for the condition)
  • environmental triggers
  • an abnormal response of the body’s natural immune system

As with other autoimmune disorders, autoimmune hepatitis means your body’s immune system attacks healthy cells similar to the way the immune system would try to fight off an infection. In this case, the healthy cells in the liver are under attack. As a result, liver tissue becomes inflamed.

This inflammation can either be acute or chronic. Acute (short-term) cases don’t always require treatment, but in rare, severe situations, it may progress to liver failure.

Chronic inflammation can cause ongoing liver injury over months or years, which may progress to scarring and liver cirrhosis. If not treated quickly, the affected tissue can become scarred and liver function can decline. Poorly controlled autoimmune hepatitis can ultimately lead to liver failure and the need for a liver transplant.

Very mild cases or inactive phases of the disease may not require treatment. However, for more serious cases, treatment to fight acute episodes is important.

For many individuals, lifelong medication use may be required to keep the body’s autoimmune response under control and preserve liver health.

The two main medications used to treat autoimmune hepatitis are:

  • prednisone: a corticosteroid
  • azathioprine: an immunomodulator or “steroid-sparing agent”

Other medications may be added in severe cases. If medications are no longer effective and liver failure is likely, a liver transplant may be necessary.

If possible, your treatment should be supervised by a hepatologist, which is a physician who specializes in liver health.

Prednisone

Prednisone is the primary corticosteroid used to treat autoimmune hepatitis. It is usually administered at a high dosage once a diagnosis is made to quickly control inflammatory flare-ups. As symptoms improve, the dosage is usually reduced.

Corticosteroids are medications that suppress inflammatory genes that are activated by diseases such as autoimmune hepatitis. Prednisone is usually the first medication prescribed to treat the condition, and one that is prescribed again in the event of relapses.

Research published in 2017 found that the mortality rate of someone treated with prednisone was about 5 percent, suggesting that the steroid is a highly effective treatment.

However, long-term use of prednisone and similar corticosteroids is associated with numerous possible side effects, including:

Another corticosteroid, budesonide, has been less studied than prednisone, but may be similarly effective and may be accompanied by fewer side effects.

Azathioprine

The most widely used immunomodulator for autoimmune hepatitis is azathioprine (Imuran). It works by interfering with the production of DNA molecules involved with inflammation.

Immunomodulators are used to treat autoimmune disorders, cancer, and other inflammatory conditions in which the body’s immune system needs to be kept in check.

Azathioprine is sometimes used along with prednisone at the outset of treatment. It can also be introduced once the dosage of prednisone is reduced as symptoms improve.

A 2017 study found that the combination of azathioprine and prednisone led to remission in about 80 to 90 percent of people with autoimmune hepatitis.

Azathioprine may cause gastrointestinal distress. Taking smaller doses twice a day and several hours apart may help relieve side effects that may come on with one large dose.

Your doctor may request regular blood tests at the onset of treatment to ensure that you are tolerating it well with low risk of side effects.

Mycophenolate mofetil

Mycophenolate mofetil is an immunosuppressant drug that reduces the intensity of the immune system’s response. It is widely used by organ transplant recipients (including liver transplants).

It is also an effective second-line treatment for autoimmune hepatitis when conventional first-line treatments haven’t been effective. In a small study from 2017, mycophenolate mofetil was used as a second-line treatment and achieved remission in about 60 percent of participants.

Side effects of this medication include nausea and headache, as well as sleep problems. You should also know that taking immunosuppressant drugs weakens the body’s ability to fight off any type of infection.

Liver transplant

If standard treatments are unable to prevent significant harm to liver function — or if treatment was started after severe liver damage already occurred — the last option is a liver transplant. When a liver transplant is needed, you are considered to have end stage liver disease.

Despite the invasive nature of a liver transplant, the long recovery, and need for immunosuppressant drugs, recipients of liver transplants often do very well. Research from 2015 suggests that the survival rate is higher than 75 percent at 5 years after transplant.

The liver is something of a workhorse, performing hundreds of functions critical to maintaining good health. Just a few of those many functions include:

  • producing bile to help break down fats and carry waste products away during digestion
  • producing cholesterol and various proteins that help move fats throughout the body
  • filtering drugs and other toxins out of the blood

Whatever you can do to protect your liver on top of taking your medications as prescribed by your doctor will help greatly. Unfortunately, there are no proven natural remedies or alternative treatments for autoimmune hepatitis. However, it’s important to try to live a healthy lifestyle that helps protect the liver.

Eating a healthy, low-fat diet and getting regular exercise are always important. You should also limit your alcohol intake to one drink per day, if at all. If you have experienced significant liver damage, your doctor will likely advise you to abstain from alcohol.

Autoimmune hepatitis is a chronic disease, meaning you will have it for the rest of your life. With proper treatment, it’s possible to enjoy years of remission without symptoms and healthy liver function.

The Canadian Society of Intestinal Research suggests that people who respond well to treatment can expect to have a normal life expectancy.

Also, a 2020 study found that with proper immunosuppressant therapy, about 90 percent of the 86 people with autoimmune hepatitis in this study achieved complete remission.

Autoimmune hepatitis is a rare but serious condition that can lead to serious liver damage and potentially be life threatening. But with prompt treatment and long-term medication maintenance, autoimmune hepatitis can often be managed to preserve a long, healthy life.

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