Autoimmune Hepatitis: Progress from Global Immunosuppression to Personalised Regulatory T Cell Therapy

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.