• Hemant Chatrath, Larissa Allen, and Thomas D Boyer.
• Department of Medicine and Liver Research Institute, University of Arizona College of Medicine, Tucson.
• Am. J. Med. 2014 Nov 1; 127 (11): 1128-1131.

BackgroundCorticosteroids and azathioprine are widely accepted as the initial therapy for autoimmune hepatitis. However, the disease is refractory to steroids in about 10%-20% of patients, for whom currently there is no standardized treatment. Here we describe our experience with sirolimus in treatment of steroid refractory autoimmune hepatitis.MethodsThis is a longitudinal follow-up study. Between November 2007 and January 2014, 5 subjects with steroid refractory autoimmune hepatitis were treated with sirolimus at our institution.ResultsA response, defined as a sustained >50% fall in alanine aminotransferase (ALT) levels, was achieved in 4/5 patients. A complete response, sustained normalization of ALT levels, was achieved in 2/5 patients. The need for steroids was significantly reduced in all patients (P < .05).ConclusionsIn this small series, sirolimus appears to be useful in the treatment of patients with steroid refractory autoimmune hepatitis.Copyright © 2014 Elsevier Inc. All rights reserved.

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