A 30-year-old man with biopsy-proven autoimmune hepatitis (type 1) is started on induction therapy. According to standard guidelines, which regimen is recommended as first-line for induction of remission?

• A Prednisolone monotherapy
• B Azathioprine monotherapy
• C Budesonide plus azathioprine
• D Prednisolone plus azathioprine ✓

Explanation

Standard guidelines (AASLD and EASL) recommend prednisolone (or prednisone) plus azathioprine as first-line induction therapy for autoimmune hepatitis. The combination allows lower corticosteroid exposure and reduces steroid-related side effects while achieving remission rates of 80 to 90%. Azathioprine monotherapy is not effective for induction. Budesonide plus azathioprine is an alternative for non-cirrhotic patients but is contraindicated in cirrhosis due to first-pass metabolism failure and risk of portal vein thrombosis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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