Albert J Czaja1. 1. Mayo Clinic and Mayo Clinic College of Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, 200 First Street SW, Rochester, Minnesota 55905, USA. czaja.albert@mayo.edu
Abstract
BACKGROUND: Prednisone and azathioprine are effective in the treatment of autoimmune hepatitis, but diverse side effects can diminish their net benefit. OBJECTIVES: Describe the frequency and nature of these side effects and propose management strategies to minimize their impact. METHODS: Pertinent articles published from 1970 to 2007 were identified by Medline search and through a personal library. RESULTS: Medication is prematurely discontinued in 13% of patients mainly because of cosmetic changes, cytopenia, or osteopenia. Populations at high risk are the elderly, those with pre-existent co-morbidities, patients with near-zero thiopurine methyltransferase activity, individuals who are treatment-dependent, pregnant women, and asymptomatic patients who are over-treated. CONCLUSIONS: Proper patient selection, effective pre-treatment counseling, preemptive protective measures, realistic treatment objectives, and early identification of problematic patients can reduce complications. Individualized dosing schedules and the emergence of non-steroidal medications are realistic expectations.
BACKGROUND:Prednisone and azathioprine are effective in the treatment of autoimmune hepatitis, but diverse side effects can diminish their net benefit. OBJECTIVES: Describe the frequency and nature of these side effects and propose management strategies to minimize their impact. METHODS: Pertinent articles published from 1970 to 2007 were identified by Medline search and through a personal library. RESULTS: Medication is prematurely discontinued in 13% of patients mainly because of cosmetic changes, cytopenia, or osteopenia. Populations at high risk are the elderly, those with pre-existent co-morbidities, patients with near-zero thiopurine methyltransferase activity, individuals who are treatment-dependent, pregnant women, and asymptomatic patients who are over-treated. CONCLUSIONS: Proper patient selection, effective pre-treatment counseling, preemptive protective measures, realistic treatment objectives, and early identification of problematic patients can reduce complications. Individualized dosing schedules and the emergence of non-steroidal medications are realistic expectations.