Alternative treatment regimens in autoimmune hepatitis: how justified is their choice?

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Abstract

Autoimmune hepatitis is a progressive immune-mediated liver disease of unknown etiology. Its key characteristics include hyper-gammaglobulinemia, circulating autoantibodies, and periportal inflammation seen in a liver biopsy sample. It is not infrequent that the lack of unified diagnostic tests makes the verification of the disease very challenging. Most patients respond well to standard immunosuppressive therapy; however, a significant proportion of them demonstrate side effects and disease relapses after treatment withdrawal. A wide range of side effects of systemic steroids and eventual disruptions with azathioprine (the agent of choice in the treatment algorithms for autoimmune hepatitis) supplies to the Russian market make it relevant to use alternative treatment regimens. In the real world practice, alternative treatment regimens are rarely used in such patients due to the absence of hard evidence of their efficacy. Low prevalence of autoimmune hepatitis, multiplicity of its clinical types, as well as a lack of understanding of its pathogeneticmechanisms hinder the synthesis of new agents and performing trials with already known immunosuppressants with a statistical power necessary to obtain persuasive data. One of solutions of the problem could be the accumulation of clinical data into registries for further systematization of the knowledge and formulation of new clinical guidelines.

About the authors

M. V. Matsievich

Tsentrosoyuz Clinical Hospital

Author for correspondence.
Email: macievich@gmail.com

Mariya V. Matsievich - MD, PhD, Head of the Department of Gastroenterology.

57 Gilyarovskogo ul., Moscow, 129110.

Tel.: +7 (925) 100 51 22.

Russian Federation

A. O. Bueverov

Moscow Regional Research and Clinical Institute (MONIKI); I.M. Sechenov First Moscow State Medical University

Email: fake@neicon.ru

Aleksey O. Bueverov - MD, PhD, Professor, Leading Research Fellow, Department of Hepatology MONIKI; Chair of Medical and Social Expert Assessment and Out-Patient Therapy, Postgraduate Medical Training Faculty; Leading Research Fellow, Department of Research on Innovative Therapy, Research Center, I.M. Sechenov First Moscow State Medical University.

61/2 Shchepkina ul., Moscow, 129110; 8/2 Trubetskaya ul., Moscow, 119991.

Russian Federation

M. Yu. Petrachenkova

Medical Center "SM-Clinic"

Email: fake@neicon.ru

Mariya Yu. Petrachenkova - MD, Gastroenterologist.

29 Marshala Timoshenko ul., 121359, Moscow.

Russian Federation

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