Current perspectives and novel trends in the treatment of autoimmune hepatitis

Abstract

Introduction: Autoimmune hepatitis is a chronic inflammatory liver disease. If left untreated, can lead to cirrhosis and end-stage liver disease, often requiring lifelong treatment. Non-specific immunosuppression remains the mainstay of its management and although proven to be effective, significant treatment advances are lacking. There's an urgent need for more tolerable, and steroid-free induction regimens, as well as targeted and effective alternatives that ensure long-lasting disease remission while avoiding widespread immunosuppression, and treatments for those unresponsive or intolerant to standard therapies. Areas covered: In this review, we discuss the evidence regarding the standard treatment of autoimmune hepatitis including induction and maintenance regimens as well as current alternatives for intolerant or non-responding patients, going through emerging therapeutics and the potential role of immunotherapy. Expert opinion: AIH research faces significant obstacles, mainly related to the disease´s rarity and the scarcity of randomized clinical data. Additionally, our understanding of the molecular mechanisms underlying autoimmune hepatitis pathogenesis remains incomplete, which limits our ability to choose therapies that directly target its specific pathways. The wide range of novel treatments currently being explored aims to enhance the balance between regulatory T cells and effector T cells which presents a promising therapeutic avenue for therapy in autoimmune hepatitis.