By Craig Lammert, M.D.
Steroids are typically used to rapidly control liver inflammation seen in autoimmune hepatitis. Ultimately, a goal of AIH care is to find a chronic immunosuppressive medication regimen that will be well tolerated by patients, control inflammation in the liver, and prevent liver fibrosis progression without the use of chronic steroids. When possible, hepatologists typically try to avoid prescribing steroids for long-term use because the side effects can be challenging for patients and include weight gain, bone loss, poor sleep, and elevated blood glucose, among others.
Unfortunately, some AIH patients may require long-term steroids for various reasons. Long-term steroids (typically lower doses) may allow chronic immunosuppressive medication to better control inflammation in the liver, may provide better control of other symptoms outside the liver (i.e. joint pain), or may be the only medication that a patient tolerates.
The scientific community has often thought that the risk of infection likely increases with chronic steroid use but that lower doses of chronic steroids may be safe. We now have data from a large group of patients with rheumatoid arthritis (RA) that helps to put this increased risk of infection in perspective. Similar to AIH, patients with RA use chronic immunosuppressants and also require steroids at times. In a study of more than 200,000 RA patients, the authors observed that patients taking less than 5 mg of prednisone a day (in addition to their chronic immunosuppression medication), 5-10 mg a day, and more than 10 mg a day ALL had higher risk of having significant infections requiring hospitalizations. In fact, the increased risk seen was dose-dependent (meaning the higher the dose of chronic steroids, the higher the risk).
The Autoimmune Hepatitis Association recommends that patients on long-term steroids have a conversation with their doctors about the benefits of chronic steroid use versus the risk of infection. While some patients may need to remain on steroids, it’s wise for doctors and patients to work together in an attempt to get patients off steroids completely or reduce the dose to the lowest possible level needed. Remember to never start or stop any medication before speaking with your medical professional.