Table 2.
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.