Provision and standards of care for treatment and follow-up of patients with auto-immune hepatitis (AIH)

Immunosuppressive therapy with corticosteroids has been for many years the mainstay of treatment for autoimmune hepatitis (AIH). UK and European guidelines recommend using high-dose oral prednisolone to induce remission in AIH, followed by the introduction of the immunosuppressant azathioprine, with tapering of the corticosteroid dose, continuing with azathioprine as long-term maintenance monotherapy or sometimes in combination with low-dose prednisolone. In contrast to the other autoimmune liver diseases, primary biliary cholangitis and primary sclerosing cholangitis, there is assumption from healthcare professionals in the UK, that AIH is a disease that can be easily and successfully managed by treatment with corticosteroids and immunosuppressants. Is this assumption justified by the evidence? In this journal, Gordon and colleagues report on the finding of an audit of service provision and care of patients with AIH in 28 UK hospitals between January 2014 and November 2015.1 The study can be criticised for the delay of 6 years in the publication of the results, but it is unlikely that the results of the audit would have significantly altered in the 6-year interim and it provides an important overview of current practices in the management of AIH in the UK. The study found that after 1 year of treatment, 82% of the patients had achieved normal serum ALT levels; and that the remission rate was higher in University Hospitals than District General Hospitals. The other significant findings were that one-third of hospitals lacked a specialist consultant hepatologist, and only 18% had the services of a specialist liver nurse involved in the management of AIH. Liver blood test monitoring was found to be performed less frequently …