Difficult to treat and refractory autoimmune hepatitis: Recent advances in pharmacological management

Table 2 Third-line immunosuppressives used in refractory autoimmune hepatitis

Drugs	Infliximab	Rituximab	Belimumab
Position in managing refractory AIH	Third line	Third line	Third line
Mechanism of action	Monoclonal antibody to TNF-α	Chimeric monoclonal antibody against CD-20	B-cell-activating factor inhibitor
Dose	5 mg/kg	2 doses of 1000 mg IV administered 2 wk apart, or 375 mg/m2 rituximab	10 mg/kg
Pregnancy category1	B	C	C
Adverse events	Infectious complications can cause drug induced AIH like injury allergic reaction	Infectious complications	Infection, allergic reactions, progressive multifocal leukoencephalopathy, and mental health issues
Comments	Response rate 78% when used as a third line agent[94]	As a third line agent biochemical remission: 67%, 71% flare-free survival after median 6 yr[88-90,121]	Steroid refractory AIH. Two patients had complete biochemical response[99]

¹These capital letters denote pregnancy category of the drugs.

AIH: Autoimmune hepatitis; TNF: Tumor necrosis factor.