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. 2016 May 18;2016:7181685. doi: 10.1155/2016/7181685

Table 2.

Overview of standard, alternative, biologic, and future Treg cellular therapies in autoimmune hepatitis.

Drug Week 1 Week 2 Weeks 3 to 8 Maintenance therapy Route Duration
Monotherapy Prednisolone (0.5 mg/kg) 40 mg 30 mg 20 mg Reduction of 5 mg/every 2-3 months Oral Once daily

Combined therapy Prednisolone (OR)
Budesonide∗∗
30 mg
9 mg
20 mg
9 mg
15 mg
6 mg
10 mg
≤6 mg
Oral Once daily
With azathioprine#
(OR)
1-2 mg/kg (in Europe) Oral Once daily
50 mg/day (in United States)
(Dose should be adjusted by 6 TG/6 MMP)
6-Mercaptourine 50 mg/day (those who cannot tolerate azathioprine) Oral Once daily

Second-line therapies Tacrolimus$ 3–5 mg/day (keep level < 6) Oral Twice daily
Mycophenolate mofetil 750–2000 mg (contraindicated in pregnancy) Oral Twice daily
Not effective if patients are previous azathioprine nonresponder

Biologic therapies Antitumour necrosis factor (TNF) therapy (infliximab) 5 mg/kg (exclude tuberculosis before treatment) Intravenous Once every 2 to 8 weeks
Anti-CD20 monoclonal antibody (Rituximab)
Other B cells manipulating therapies
1000 mg (deep immunophenotype of B and T cells; exclude past hepatitis B infection) Intravenous Twice (2 weeks apart)

Cell therapy
Autologous regulatory T cell therapy
(Both for induction and
maintenance therapy)
Polyclonal or antigen-specific Intravenous   Trial phase

∗∗Suitable for noncirrhotic patients with steroid side effects, brittle diabetes mellitus, and osteoporosis.

#6-TGN and 6-MMP levels should be monitored for safe therapeutic range. Avoid using with allopurinol. Some centres measure TPMT level prior to starting treatment.

$Require therapeutic drug level and renal function monitoring.