Challenges in the use of corticosteroids in the management of autoimmune hepatitis

Research output: Contribution to journalArticlepeer-review

Authors

  • Roger W Chapman
  • Richard J Aspinall
  • Palak Trivedi
  • Gavin Wright
  • Michael Heneghan

Colleges, School and Institutes

External organisations

  • University of Oxford
  • Consultant Hepatologist
  • Basildon & Thurrock University Hospital
  • King’s College London

Abstract

Autoimmune hepatitis is widely assumed by health-care professionals to be a disease that is easily controlled through the use of corticosteroids and immunosuppressants but recent studies in the UK indicate highly variable treatment regimens and often unsatisfactory treatment outcomes, such as dependence on long-term high-dose steroids and ongoing need for liver transplantation in some cases. The therapeutic use of the systemically acting corticosteroid prednisolone results in unacceptable side effects in many patients. Recent evidence suggests that it is not always necessary to use high-dose steroids (>0.5 mg/kg/d) to attain remission; and side effects may also be minimised through more targeted therapy with the less systemically-absorbed corticosteroid, budesonide. The authors offer advice on the stratification of treatment for these patients and suggest changes to improve the services available for people with autoimmune hepatitis in the UK.

Details

Original languageEnglish
Pages (from-to)594-599
Number of pages6
JournalBritish journal of hospital medicine
Volume80
Issue number10
Publication statusPublished - 2 Oct 2019

Keywords

  • Adrenal Cortex Hormones/therapeutic use, Budesonide/administration & dosage, Dose-Response Relationship, Drug, Hepatitis, Autoimmune/drug therapy, Humans, Liver Transplantation/methods, Medication Adherence, Patient Satisfaction, Prednisolone/administration & dosage, Quality Improvement, Quality of Life

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