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. 2012 Sep;26(9):615–620. doi: 10.1155/2012/512132

TABLE 1.

Alternative drugs to prednisone for autoimmune hepatitis

Drug, dose (reference[s]) Mechanism of action (reference[s]) Clinical indication (reference[s]) Outcomes (reference[s])
Cyclosporine, 2 mg/kg/day to 5 mg/kg/day (26) Calcineurin inhibitor (19)
Impairs NF-κB (19)
Reduces IL-2 (19)
Impairs lymphocyte proliferation (19)		 Steroid-failure (20–26) Composite results (20–26):

  • Improvement, 93%

  • Failure/side effects, 7%
Tacrolimus, 0.5 mg/day to 3 mg twice/day (27–29) Calcineurin inhibitor (19)
Impairs NF-κB (19)
Reduces IL-2 (19)
Impairs lymphocyte proliferation (19)		 Steroid-failure (27–29) Composite results (27–29):

  • Improvement, 98%

  • Failure/side effects, 2%
Mycophenolate mofetil, 0.5 g/day to 3 g/day (41) Purine antagonist (30)
Inhibits inosine monophosphate dehydrogenase (30)
Limits purine nucleotides (30)
Impairs lymphocyte proliferation (30)		 Azathioprine intolerance (main) (37,41)
Steroid-failure (less effective) (37,41)
Front-line therapy (uncertain preference) (42)		 Salvage outcomes (31–41):

  • Overall improvement, 47%

  • Azathioprine intolerance, 58%

  • Refractory disease, 12%

  • Failure or side effects, 53%

  • Steroid withdrawal, 40%

  • Serious side effects, 3–33%
Front-line outcomes (42):

  • Complete response, 88%

  • Partial response, 12%

  • Steroid withdrawal, 58%

  • Serious side effects, 3%
Budesonide, 3 mg three times/day combined with azathioprine (47) Anti-inflammatory (46)
High hepatic clearance (48)
Inactive metabolites (48)		 Front-line therapy (47)
No cirrhosis (53)
Mild disease (49)
Prednisone risk (49)		 After 6 months of therapy (47):

  • Laboratory normalization, 47%

  • Side effects, 28%

IL-2 Interleukin-2; NF-κB Nuclear factor kappa-B