Treatment of autoimmune hepatitis.

Corticosteroid therapy is effective in all forms of autoimmune hepatitis, and the combination of prednisone and azathioprine is preferred. Remission can be achieved in 80% of patients within 3 years, and the 10- and 20-year survival rates exceed 80%. Histological cirrhosis does not affect response or longevity, and all patients with severe disease should be treated, including children, elderly adults, postmenopausal women, individuals with acute or fulminant presentations, and those without conventional autoantibodies. Relapse is common, and long-term low-dose prednisone or azathioprine therapy is preferred after multiple relapses. Sustained remission is achievable, even after relapse, in 47% within 10 years, and the long-term maintenance regimens need not be indefinite. Liver transplantation is effective, and its actuarial 10-year survival rate is 75%. Drugs such as cyclosporine, tacrolimus, and mycophenolate mofetil promise greater blanket immunosuppression, and site-specific interventions are feasible, including blocking peptides, soluble cytotoxic T lymphocyte antigen-4, cytokine manipulations, T cell vaccination, oral tolerance, and gene therapy.