From the Guidelines

Prednisone plays a crucial role in the treatment of autoimmune hepatitis as a first-line immunosuppressive therapy.

The standard treatment regimen consists of prednisone or prednisolone, either alone or in combination with azathioprine, to induce biochemical remission, defined as normalization of both serum aminotransferase and immunoglobulin G (IgG) levels 1.
The majority of patients respond well to steroid-based immunosuppressive treatment, with serum transaminases improving to levels within the normal range 1.

The initial dosage of prednisone is typically high, with a gradual tapering to maintenance doses, often in combination with azathioprine 1.
The combination of azathioprine 1 mg/kg and prednisolone is a suggested induction strategy for autoimmune hepatitis (AIH) 1.

Prednisone therapy has been shown to improve survival, liver biochemical tests, and liver histology in patients with AIH 1.
Treatment with prednisone or prednisolone with or without azathioprine can induce biochemical improvement in up to 90% of patients within 12 months 1.
However, despite these successes, the mortality of patients treated with standard of care immunosuppressive therapy remains significantly higher than that of the normal population 1.

From the Research

Prednisone is a corticosteroid used in the treatment of autoimmune hepatitis, often in combination with azathioprine 2, 3.
The combination of prednisone and azathioprine is the preferred treatment for severe type 1 autoimmune hepatitis, especially in the elderly, due to a lower incidence of corticosteroid-related complications 2.
Prednisone can be used as monotherapy or in combination with azathioprine as a first-line treatment for autoimmune hepatitis 3.

Prednisone has been shown to induce long-term remission in patients with autoimmune hepatitis, but it can have many side effects 4, 5.
The efficacy of prednisone in inducing complete biochemical remission has been compared to budesonide, with budesonide showing promise in inducing remission with fewer adverse effects 4.
However, a recent real-life study revealed higher complete biochemical response rates with prednisone when equivalent initial doses were administered 3.

Alternative treatments, such as mycophenolate mofetil, tacrolimus, and budesonide, are being explored for patients who are intolerant to azathioprine or have failed first-line treatment 3, 6.
A systematic review and meta-analysis found that mycophenolate mofetil had a reasonable histological remission rate, while combined tacrolimus/prednisone was the most effective for normalizing aminotransferases 6.

Serum aspartate aminotransferase and gamma-globulin levels are useful indices to monitor during therapy, and liver tissue examination is the best method of evaluating completeness of response 2.
Proper patient selection, effective pre-treatment counseling, preemptive protective measures, realistic treatment objectives, and early identification of problematic patients can reduce complications associated with prednisone treatment 5.