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Recurrent Drug-Induced Liver Injury (DILI) with different drugs in the Spanish Registry: The dilemma of the relationship to autoimmune hepatitis

Lucena, M.I., Kaplowitz, N., Hallal, H., Castiella, A., García-Bengoechea, M., Otazua, P., Berenguer, M., Fernandez, M.C., Planas, R., Andrade, R.J.·2011·Journal of Hepatology
DOI 10.1016/j.jhep.2010.12.041
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Abstract

Background & aims Multiple instances of DILI in the same patient with drugs of similar structure or function as well as completely unrelated drugs are not well understood and poorly documented. We have sought evidence of the frequency and characteristics of patients who have experienced two DILI episodes due to different drugs. Methods All cases of DILI systematically collected in the Spanish DILI Registry between 1994 and 2009 were retrieved. Data on demographics, clinical, laboratory and pathological findings, and outcome were analyzed. Results Nine patients (mean age 67 years, four women) out of 742, 1.21%, had evidence of two DILI episodes caused by different drugs. In four cases DILI was associated with structurally related drugs and in an additional two cases the drugs had a common target. In another case, unrelated antibiotics were implicated. In only two cases, the two drugs/herbals were not related in structure or function. All but one patient exhibited hepatocellular damage. The type of damage was consistent in both DILI episodes. Four cases presented as autoimmune hepatitis (AIH) in the second episode. Conclusions Multiple episodes of DILI in association with different drugs occur infrequently. In each individual, the type of injury was similar during the two DILI episodes, regardless of the causative drug. Second episodes of DILI are more likely to be associated with features of AIH. It remains uncertain if this is drug-induced unmasking of true AIH or DILI with a…

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  • Whether a given case of acute liver injury with an autoimmune phenotype is drug-induced unmasking of subclinical AIH or de novo DILI accompanied by autoimmune features may be difficult to distinguish.

    “Whether a given case of acute liver injury with an autoimmune phenotype is the drug-induced unmasking of subclinical AIH or de novo drug-induced liver injury (DILI) accompanied by autoimmune features may be difficult to distinguish (Box 1).”

    From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [7]

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Metadata

Authors
Lucena, M. I., Kaplowitz, N., Hallal, H., Castiella, A., García-Bengoechea, M., Otazua, P., Berenguer, M., Fernandez, M. C., Planas, R., & Andrade, R. J.
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2011-10
Volume
55
Issue
4
Pages
820-827
ISSN
0168-8278
DOI
10.1016/j.jhep.2010.12.041
Cited by
89
References
1
Language
en
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Funders
Agencia Española del Medicamento and Fondo de Investigación Sanitaria (FIS 07-0980, SAS PI 0082/207, PS 09/01384)

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