azathioprine + budesonide

Azathioprine + budesonide is a combination therapy used primarily for the induction and maintenance of remission in autoimmune hepatitis (AIH), particularly in patients without cirrhosis. Azathioprine is an immunosuppressive antimetabolite that inhibits purine synthesis, thereby suppressing B and T lymphocyte proliferation. Budesonide is a synthetic glucocorticoid with high first-pass hepatic metabolism, resulting in potent local anti-inflammatory effects with reduced systemic side effects compared to other corticosteroids like prednisone. The combination leverages azathioprine’s long-term immunosuppression with budesonide’s rapid anti-inflammatory action to control liver inflammation, improve liver function tests, reduce scarring, and prevent progression to liver failure[1][2][4][5]. This regimen has demonstrated efficacy in both adult and pediatric AIH populations as an alternative to traditional prednisone-based regimens[1][2].