Autoimmune-like hepatitis induced by drugs: Still many unanswered questions

Table 3 Comparison of corticosteroid treatment in classic autoimmune hepatitis vs drug-induced autoimmune like hepatitis

Parameter	Classic AIH	DI-ALH
Initial steroid dose	Prednisone 30-60 mg/day (or equivalent)	Prednisone 20-40 mg/day (or equivalent)
Induction strategy	Often combined with azathioprine	Monotherapy with steroids usually sufficient
Tapering schedule	Gradual taper over months based on biochemical response	Faster taper once liver enzymes normalize
Duration of treatment	Long-term (often > 2 years, sometimes lifelong)	Short-term (typically < 6-12 months)
Need for maintenance therapy	Common (azathioprine or other immunosuppressants)	Rare; usually not required after resolution
Relapse after withdrawal	Frequent (up to 50%-80%)	Rare
Histologic recovery	Slower, often incomplete even after biochemical remission	Usually complete. Once drug is withdrawn inflammation resolves
Outcome/prognosis	Good with treatment, but risk of chronic disease or cirrhosis	Excellent prognosis; usually resolves without chronic sequelae
Lifelong monitoring needed	Yes	Case by case assessment

AIH: Autoimmune hepatitis; DI-ALH: Drug-induced autoimmune-like hepatitis.