Advancing Autoimmune Hepatitis Treatment and Research, with Craig Lammert, MD
Lammert describes the lack of developments in autoimmune hepatitis care over the past several decades and points to what might be next in disease management.
For decades, the autoimmune hepatitis (AIH) treatment landscape has remained stagnant, relying on the same standard therapies with little innovation.
AIH is a rare chronic disease, with little known about its etiology and pathophysiology. Additionally, epidemiological data on AIH is scarce and likely unreported and underrecognized.1
“The standard of care that we've been using for almost 70 years really has not evolved,” Craig Lammert, MD, an associate professor of medicine at Indiana University School of Medicine and executive director for the Autoimmune Hepatitis Association, explained to HCPLive. “We have very much used azathioprine, or Imuran, as a hammer and the patients as a nail.”
He notes that recent studies have sought to widen the standard of care, specifically referencing the CAMARO trial comparing azathioprine and mycophenolate mofetil, both in combination with prednisolone, for the induction of biochemical remission in treatment-naive patients with AIH. Results showed mycophenolate mofetil with prednisolone led to a significantly higher rate of biochemical remission at 24 weeks with fewer adverse events compared to azathioprine combined with prednisolone.2
Still, Lammert points out a significant proportion of patients fail to achieve biochemical response with currently available therapies and face long-term corticosteroid dependence.
“Anything we can do to herald in a new wave of clinical trials, and how we design those trials to not suffer from what we've seen in the PBC space, but also to identify agents and test them in a way to get full approval, would be tremendously impactful for autoimmune hepatitis patient populations,” he said.
In the meantime, Lammert describes efforts to optimize current standard of care and assess tools for long-term disease monitoring, including FibroScan.
“More to come on this area, and again, an exciting area, but we need so much more collaboration and patient-level data,” he said. “I think this will help guide us into the future, and hopefully, autoimmune hepatitis will catch up with all the other autoimmune diseases in terms of treatment and more individualized level of care.”
Editors’ note: Lammert has relevant disclosures with Eli Lilly, Kezar Life Sciences, and the Autoimmune Hepatitis Association.
References
Linzay CD, Sharma B, Pandit S. Autoimmune Hepatitis. StatPearls. August 14, 2023. Accessed March 25, 2025. https://www.ncbi.nlm.nih.gov/books/NBK459186/
Snijders RJALM, Stoelinga AEC, Gevers TJG, et al. An open-label randomised-controlled trial of azathioprine vs. mycophenolate mofetil for the induction of remission in treatment-naive autoimmune hepatitis. J Hepatol. doi:10.1016/j.jhep.2023.11.032
