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Setting up criteria for drug‐induced autoimmune‐like hepatitis through a systematic analysis of published reports

Björnsson, Einar S., Medina‐Caliz, Inmaculada, Andrade, Raul J., Lucena, M. Isabel·2022·Hepatology Communications
DOI 10.1002/hep4.1959PMC PMC9315110
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Abstract

Nitrofurantoin, minocycline, methyldopa and infliximab, have been found to induce autoimmune‐like hepatitis (DI‐AILH). Evidence for other drugs and herbal and dietary supplements (HDS) is unclear. The aims of the study were to establish criteria to define and review the published evidence of suspected DI‐AILH. Search was undertaken in Pubmed using search terms “drug‐induced liver injury,” “autoimmune hepatitis,” and “drug‐induced autoimmune hepatitis.” DI‐AILH was defined as (1) drug as a potential trigger of liver injury with autoimmune features and histological findings compatible with AIH; (2) no or incomplete recovery or worsening of liver tests after discontinuation of the drug; (3) corticosteroids requirement or spontaneous recovery; (4) follow‐up without immunosuppression (IS) and no relapse of AIH at least 6 months after discontinuation of IS; and (5) drugs potentially inducing AILH with a chronic course. Cases fulfilling the first four criteria were considered probable DI‐AILH with three possible DI‐AILH. A total of 186 case reports were identified for conventional drugs (n = 148; females 79%; latency 2.6 months) and HDS (n = 38; females 50%). The most commonly reported agents of DI‐AILH were interferons (n = 37), statins (n = 24), methylprednisolone (MPS) (n = 16), adalimumab (n = 10), imatinib (n = 8), and diclofenac (n = 7). Tinospora cordifolia and Khat were the only HDS with probable DI‐AILH cases. No relapses of AIH were observed when IS was stopped after interferons, imatinib, diclofenac, and methylprednisolone. Conclusion: Beyond well‐recognized nitrofurantoin, methyldopa, hydralazine, minocycline, and infliximab as causes of DI‐AILH, interferons, imatinib, adalimumab, and MPS were the best‐documented agents leading to probable DI‐AILH. Khat and Tinospora cordifolia were the only HDS found to be able to induce DI‐AILH. Long‐term immunosuppression appears to be rarely required in patients with DI‐AILH due to these drugs.

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Metadata

Authors
Björnsson, E. S., Medina‐Caliz, I., Andrade, R. J., & Lucena, M. I.
Affiliations
  • Faculty of Medicine,University of Iceland,Reykjavik,Iceland
  • UGC Aparato Digestivo and Servicio de Farmacología Clínica,Instituto de Investigación Biomédica de Málaga‐IBIMA,Hospital Universitario Virgen de la Victoria,Universidad de Málaga,Málaga,Spain
Venue
Hepatology Communications
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-05-21
Volume
6
Issue
8
Pages
1895-1909
ISSN
2471-254X
DOI
10.1002/hep4.1959
PMC
PMC9315110
Cited by
55
References
1
Language
en
Licence
creativecommons.org/licenses/by-nc-nd/4.0/ (unspecified)

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