{
  "abstract": "Autoimmune hepatitis (AIH) may present with a diverse spectrum of clinical manifestations and disease stages. It is a life-threatening condition that, if undiagnosed or inadequately treated, can progress to liver failure, cirrhosis and decompensation. The primary goals of treatment are to prevent both acute and chronic liver failure while preserving quality of life. Various obstacles to achieving these goals contribute to difficult-to-treat AIH. One of the most significant advancements has been the shift towards personalised treatment, particularly through the fine-tuning of thiopurine therapy using metabolite monitoring and combination with low-dose allopurinol when necessary. Mycophenolate mofetil (MMF) has solidified its role as a leading second-line option in thiopurine intolerant patients. A controversial head-to-head randomised controlled trial comparing MMF with azathioprine as a first-line treatment has further advanced MMF’s position as a therapeutic option. MMF may now be considered a valid first-line option in carefully selected cases. Tacrolimus remains the preferred third-line agent, with the most extensive clinical experience supporting its long-term use. Among biological therapies, infliximab and rituximab have taken a leading role in the management of refractory AIH. These therapies are poised to play an increasingly significant role in both induction and maintenance treatment in the future. In this review, we summarise the therapeutic strategies for difficult-to-treat AIH, from thiopurine optimisation to the emerging role of biologic therapies.",
  "authors": [
    {
      "affiliations": [
        "Institute of Liver Studies, King’s College Hospital, London, UK"
      ],
      "name": "Ilkay Ergenc"
    },
    {
      "affiliations": [
        "Institute of Liver Studies, King’s College Hospital, London, UK"
      ],
      "name": "Michael A Heneghan"
    }
  ],
  "title": "Therapeutic pipeline for difficult-to-treat autoimmune hepatitis",
  "uid": "a90206ff-bf71-5881-a849-880ceff59439"
}