Autoimmune Hepatitis Treatment: Can Low-Dose Steroids Be Generalized?

We critically examine the implications of Aggarwal et al.'s study on low- versus high-dose prednisolone induction in autoimmune hepatitis (AIH). While acknowledging the study's contribution, this letter argues that the predominantly cirrhotic and often decompensated patient cohort limits the generalizability of its findings to the broader AIH population. We emphasize the potential influence of advanced liver disease on treatment response and side effect profiles, suggesting that similar efficacy between low- and high-dose prednisolone may not extend to all AIH patients. We contend that future research should prioritize more representative AIH cohorts across the spectrum of disease severity to establish universally applicable corticosteroid dosing strategies.