Autoimmune liver diseases in the Asia Pacific region: proceedings of the autoimmune liver disease course at APASL 2025.

BACKGROUND AND AIMS: Autoimmune liver diseases (AILD) have historically been considered uncommon in the Asia-Pacific region, where viral hepatitis has predominated as the leading cause of chronic liver disease. However, their recognition and clinical relevance have increased substantially in recent years, mirroring global epidemiologic trends. This proceedings report summarizes the educational course on AILD held during the 34th Annual Meeting of the Asian Pacific Association for the Study of the Liver (APASL) in 2025, highlighting contemporary insights into disease burden, diagnosis, and management across diverse populations.

METHODS

International experts presented updated evidence and region-specific considerations concerning autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and IgG4-related sclerosing cholangitis. Key advances in risk stratification, imaging, serology, patient-reported outcome measures (PROMs), and emerging therapeutics were synthesized.

RESULTS

Important updates included improved understanding of acute presentations of AIH, evolving risk stratification and second-line pharmacologic approaches in PBC, and advances in PSC diagnostics incorporating novel imaging modalities and emerging autoantibodies. The unique clinical phenotype and steroid responsiveness of IgG4-related sclerosing cholangitis were also emphasized. Increasing incorporation of PROMs into clinical practice and trials, as well as progress in targeted therapies-such as peroxisome proliferator-activated receptor agonists, farnesoid X receptor agonists, and ileal bile acid transporter inhibitors-reflects a shift toward precision medicine and improved quality of life.

CONCLUSIONS

AILD represents a growing clinical challenge in the Asia-Pacific region. Earlier recognition, individualized treatment strategies, and strengthened multinational collaboration are essential to address unmet diagnostic and therapeutic needs and to improve long-term outcomes.