Prednisolone serves as a cornerstone of treatment for autoimmune hepatitis (AIH)-related cirrhosis. It directly targets the underlying autoimmune process, suppressing inflammation and slowing disease progression. The aim is to induce remission, defined as normalization of liver enzyme levels and histological improvement.
Dosage and Administration
Typical initial prednisolone dosage ranges from 30-60 mg daily, gradually tapered based on clinical response and liver biopsy findings. Azathioprine, a second-line immunosuppressant, is often added to maintain remission and allow for prednisolone dose reduction, minimizing side effects. Close monitoring of blood counts and liver function is mandatory due to potential adverse effects.
Monitoring and Response
Regular liver function tests (LFTs) and imaging studies assess treatment response. Significant improvements in LFTs and a decline in inflammation on liver biopsy indicate successful treatment. Failure to achieve remission or relapse after achieving remission warrants reassessment of treatment strategy, potentially involving higher doses of prednisolone or the introduction of additional immunosuppressants, such as mycophenolate mofetil.
Side Effects and Management
Prednisolone’s side effects include weight gain, hyperglycemia, osteoporosis, and increased susceptibility to infections. Careful patient management addresses these side effects through dietary modifications, lifestyle adjustments, supplemental calcium and vitamin D, and prophylactic measures against infections. Close monitoring of blood glucose and bone mineral density is necessary.
Alternative Treatment Options
In cases of prednisolone intolerance or treatment failure, alternative immunosuppressants, such as budesonide or other biologics, provide viable therapeutic options. These alternatives offer varying efficacy and side-effect profiles, necessitating careful selection based on individual patient characteristics and response to initial treatment.
