-G2: once G1, wean over 2 weeks; re-escalate if worsening; treatment may be resumed once prednisolone < 10 mg
-G3/4: once improved to G2, can change to oral prednisolone and wean over 4 weeks; for G3, rechallenge only at consultant discretion
Worsening despite steroids:
– If on oral change to i.v. (methyl)prednisolone
– If on i.v. add MMF 500-1000 mg b.d.
– If worse on MMF, consider addition of tacrolimus
– A case report has described the use of anti-thymocyte globulin in steroid + MMF-refractory fulminant hepatitis