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Drug-Induced Autoimmune Hepatitis: Clinical Characteristics and Prognosis
Abstract
Drug-induced autoimmune hepatitis (DIAIH) has been reported to be caused by several drugs. There is a lack of data comparing these patients with other patients with autoimmune hepatitis (AIH). A search was performed using the Mayo Clinic diagnostic medical index for AIH patients and DIAIH patients identified over 10 years. Individuals with overlap syndromes and decompensated liver disease were excluded. Overall, 261 patients (204 females, median age 52) were identified, and 24 (9.2%) were DIAIH cases with a median age of 53 (interquartile range, 24-61). Two drugs, nitrofurantoin (n = 11) and minocycline (n = 11), were the main causes. A similar proportion of DIAIH patients had positive antinuclear antibodies (83% versus 70%) and smooth muscle antibodies (50% versus 45%) as compared with AIH patients. Histological grade and stage were similar in patients with DIAIH versus AIH; however, none of the DIAIH patients had cirrhosis at baseline; this was present in 20% of matched AIH cases. Liver imaging was normal in all minocycline cases. Eight of 11 (73%) nitrofurantoin patients had abnormalities on hepatic imaging (mainly liver atrophy), a finding seen in only 8 of 33 (24%) of a random sample of the rest of the AIH group ( P = 0.0089). Corticosteroid responsiveness was similar in DIAIH and the AIH patients. Discontinuation of immunosuppression was tried and successful in 14 DIAIH cases, with no relapses (0%), whereas 65% of the AIH patients had a relapse after discontinuation of immunosuppression ( P < 0.0001). Conclusion: A significant proportion of patients with AIH have drug-induced AIH, mainly because of nitrofurantoin and minocycline. These two groups have similar clinical and histological patterns. However, DIAIH patients do not seem to require long-term immunosuppressive therapy. (Hepatology 2010;)
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Minocycline, nitrofurantoin, methyldopa, and infliximab are the most commonly implicated drugs in DI-ALH.
“Minocycline, nitrofurantoin, methyldopa, and infliximab are the most commonly implicated drugs”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
The liver damage in DI-ALH usually manifests clinically within 3 months of drug exposure, but can appear after more prolonged latency.
“The liver damage in DI-ALH usually manifests clinically within 3 months of drug exposure, but can appear after more prolonged latency.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
Histological characteristics do not seem to enable distinction between DI-ALH and AIH.
“Histological characteristics do not seem to enable distinction between these entities.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
The microscopic findings that might help to discriminate between DI-ALH and AIH are largely unknown, except for advanced fibrosis (i.e., cirrhosis), which is observed only in AIH, but not DI-ALH.
“The microscopic findings that might help to discriminate between the two conditions are largely unknown, except for advanced fibrosis (i.e., cirrhosis), which is observed only in AIH, but not DI-ALH.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
Treatment decisions are often based on experience gained from case reports or expert opinion.
“Treatment decisions are often based on experience gained from case reports or expert opinion.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
Whilst a greater degree of fibrosis has been reported in AIH, this may be a reflection of disease chronicity rather than reflective of aetiology.
“Whilst a greater degree of fibrosis has been reported in AIH,14,16,48 this may be a reflection of disease chronicity rather than reflective of aetiology.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
A limited number of studies comparing liver histology between DI-ALH and AIH have been undertaken.
“A limited number of studies comparing liver histology between DI-ALH and AIH have been undertaken.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
In DI-ALH, after withdrawal of the causative agent and with institution of immunosuppression, the outcome is generally good in most cases, with a low risk of relapse or progression to chronic liver injury.
“After the withdrawal of the causative agent and with institution of immunosuppression, the outcome in DI-ALH is generally good in most cases, with a low risk of relapse or progression to chronic liver injury, as reported in different studies with heterogeneous follow-up (Table 1).14,17,34,35,50”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
Most cases of DI-ALH rarely relapse in the long-term follow-up after discontinuation of corticosteroid or immunosuppressive therapy.
“Unlike AIH, most cases of DI-ALH rarely relapse in the long-term follow-up after the discontinuation of corticosteroid or immunosuppressive therapy [83,84], which is the key information that indicates the probability of DI-ALH, particularly for patients with a history of classical drug exposure.”
From Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update (2024) · cites this paper as [83]
Cirrhosis is less common in the DI-ALH group than in AIH.
“with the exception of cirrhosis being less common in the DI-ALH group”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
There is no recurrence after discontinuation of immunosuppression in DI-ALH.
“and no recurrence after discontinuation of immunosuppression”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
Patients with DI-ALH and those with idiopathic AIH have very similar clinical, biochemical, immunological and histological features.
“Previous studies have revealed that patients with DI-ALH and those with idiopathic AIH have very similar clinical, biochemical, immunological and histological features.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
Corticosteroid responsiveness was similar in both the DI-ALH and AIH groups.
“Corticosteroid responsiveness was similar in both the DI-ALH and AIH groups.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
Discontinuation of immunosuppression was successful in all DI-ALH cases, whereas 65% of patients with AIH had a relapse after withdrawal of immunosuppression.
“Discontinuation of immunosuppression was successful in all DI-ALH cases, whereas 65% of patients with AIH had a relapse after withdrawal of immunosuppression”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [14]
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Metadata
- Authors
- Björnsson, E., Talwalkar, J., Treeprasertsuk, S., Kamath, P. S., Takahashi, N., Sanderson, S., Neuhauser, M., & Lindor, K.
- Venue
- Hepatology
- Published
- 2010-06
- Volume
- 51
- Issue
- 6
- Pages
- 2040-2048
- ISSN
- 0270-9139
- Cited by
- 436
- References
- 0
- Language
- en
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