This review appraises current gaps in autoimmune hepatitis (AIH) management, with focus on special populations (e.g., elderly, pediatric, pregnant), treatment limitations of first- and second-line agents, emerging therapies, and patient-reported outcomes including fatigue, depression, and cognitive dysfunction.
Fewer than 70% of patients achieve complete biochemical response (normal aminotransferases and IgG) by 6 months on standard therapy; more than 20% discontinue due to side effects. Evidence for second- and third-line agents comes largely from uncontrolled real-world studies. No validated AIH-specific symptom questionnaires or regulatory-accepted trial endpoints currently exist.
- This is a narrative review without systematic search or meta-analysis, limiting the strength of conclusions. - Evidence base for advanced therapies relies heavily on uncontrolled, real-world data with no comparator groups. - Special AIH populations (e.g., pediatric, elderly, pregnant) are understudied, reducing generalizability.
Standard AIH therapy leaves a substantial proportion of patients without full response or with intolerable side effects — clinicians should proactively monitor for fatigue, mood, and cognitive symptoms alongside liver enzymes. Emerging targeted agents may offer better tolerability, but robust trial data are still lacking.
Explore related topics
