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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 27, 2025; 17(9): 110264
Published online Sep 27, 2025. doi: 10.4254/wjh.v17.i9.110264
Published online Sep 27, 2025. doi: 10.4254/wjh.v17.i9.110264
Difficult to treat and refractory autoimmune hepatitis: Recent advances in pharmacological management
Sayan Malakar, Mayank Agarwal, Anubhav Pawar, Department of Gastroenterology, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
Umair Shamsul Hoda, S Rakesh Kumar, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Suprabhat Giri, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India
Arghya Samanta, Department of Pediatric Gastroenterology, Institute of Post Graduate Medical Education & Research, Kolkata 700020, West Bengal, India
Akash Roy, Uday C Ghoshal, Department of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospital, Kolkata 700054, West Bengal, India
Rajat Gupta, Department of General Medicine, Mackay Base Hospital, Queensland 4740, Australia
Sumit Rungta, Department of Medical Gastroenterology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
Author contributions: Malakar S, Shamsul Hoda U, Giri S, Agarwal M, Pawar A, Gupta R were responsible for preparation of the manuscript; Roy A, Samanta A, Giri S, Ghoshal UC, Rungta S, Kumar SR, Agarwal M, Pawar A were responsible for supervision, revision of the manuscript and intellectual inputs; Malakar S, Shamsul Hoda U, Giri S were responsible for final draft preparation.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sumit Rungta, MD, Additional Professor, Department of Medical Gast
Received: June 3, 2025
Revised: June 19, 2025
Accepted: August 22, 2025
Published online: September 27, 2025
Processing time: 114 Days and 20.5 Hours
Revised: June 19, 2025
Accepted: August 22, 2025
Published online: September 27, 2025
Processing time: 114 Days and 20.5 Hours
Core Tip
Core Tip: Immunosuppressive therapy remains the mainstay for patients with autoimmune hepatitis (AIH). However, managing AIH in special situations, such as acute-on-chronic liver failure, pregnancy, old age, and hepatitis B and C co-infection, can be challenging. Between 10% and 20% of patients may not respond to standard first-line immunosuppressive therapy. This review focuses on the individualized management of patients with difficult-to-treat or refractory AIH and recent advances in second- and third-line immunosuppressive therapy.