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This is a Literature Review study.

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

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This review highlights recent advances in pharmacological management of autoimmune hepatitis, indicating challenges faced in treatment response.

Patients with autoimmune hepatitis often remain refractory to first-line immunosuppressive therapy, with 10%-25% not responding.
Concurrent conditions like hepatitis C virus or metabolic dysfunction can complicate AIH treatment and should be addressed.
Second- and third-line therapies for difficult-to-treat AIH include mycophenolate mofetil and rituximab.
Refractory autoimmune hepatitis encompasses cases with intolerable side effects and severe complications like acute liver failure.

Malakar et al. (2025) studied this question.

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This review highlights recent advances in pharmacological management of autoimmune hepatitis, indicating challenges faced in treatment response.