Autoimmune Hepatitis — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyAutoimmune HepatitisRACP Adult Medicine

A 45-year-old woman with autoimmune hepatitis on azathioprine and prednisolone presents for review. Her ALT has normalised and IgG is within range. She asks about stopping treatment. What is the minimum duration of treatment before considering withdrawal?

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Correct answer: C — At least 2 years of biochemical and immunological remission

Immunosuppressive treatment for autoimmune hepatitis should be maintained for at least 2 years, with complete normalisation of ALT and IgG (biochemical remission) AND ideally histological remission on liver biopsy before considering withdrawal. Even then, relapse rates are high (50–90%), particularly in the first year after cessation. Many patients require lifelong low-dose maintenance therapy. The decision to withdraw should involve shared decision-making.

Reference: eTG – 2025 – Gastrointestinal; AASLD – 2020 – Autoimmune Hepatitis Guidelines