Autoimmune hepatitis: Towards a personalized treatment

Table 2 Special considerations when choosing a treatment for specific populations

Population	Less-desirable options	Reasons	Available options
Obesity and metabolic syndrome	Steroids	Weight gain; Arterial hypertension; Steroid-induced hyperglycemia	Induction with cyclosporin A: Trough target of 250 ng/mL for 3 months and decrease to 200 ng/mL for the next 3 months. Tapering of cyclosporin with addition of 0.3-0.5 mg/kg daily prednisone for 3 months, and then every other day for another 3 months. Azathioprine at usual dose from the 6th month onwards; Induction with rituximab at 375 mg/m2 once a week for 4 weeks. Maintenance with the same dose every 6 months. Adapt according to lymphocyte (CD20 +) count and IgG levels
Adolescents; Eating disorders; Body dysmorphia	Steroids; CsA	Weight gain; Stretch marks; Acne; Growth stunting; Psychosis and suicidal ideation; Hypertrichosis; Gingival hyperplasia	Budesonide at doses of 9 mg for induction, with progressive tapering to 6 mg and then 3 mg. Maintenance with azathioprine: Rituximab induction as previously mentioned. Maintenance with rituximab or azathioprine; Prednisone at 0.5-1 mg/kg daily + CsA targeting 200 ng/mL for 3-6 months as induction
Concomitant autoimmune disorders	NA	Treatment should be aimed at controlling all the conditions simultaneously with the smaller number of medications possible	In antibody-mediated diseases: Rituximab at 375 mg/m2 for induction and maintenance
Inflammatory bowel disease	NA		Infliximab at 5-10 mg/kg at week 0, 2, and 6 for induction. Maintenance with a dose every 4 weeks to 8 weeks. Doses and frequencies are adapted according to IBD activity; Although not yet proven, in this scenario the use of JAK inhibitors may become useful, although no evidence exists presently
Non-compliance	Steroids; CsA; Tacrolimus	Medications with significant side effects, requiring multiple daily doses, and with a set therapeutic range are less desirable	Rituximab ensures the compliance of patients as doses are administered a few times a year and under healthcare personnel surveillance

CD: Cluster of differentiation; CsA: Cyclosporin A; IBD: Inflammatory bowel disease; JAK: Janus kinases; NA: Not applicable.