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Cited by 166Drug-Induced Hepatotoxicity and ProtectionLiver Diseases and ImmunityIgG4-Related and Inflammatory Diseases

The DOI matches its Crossref record; 87 of the 89 references it cites were found in a registry or an index; 2 of the 151 sources its claims cite were checked for support.

Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report

Open access
Andrade, Raúl J., Aithal, Guruprasad P., de Boer, Ynto S., Liberal, Rodrigo, Gerbes, Alexander, Regev, Arie, Terziroli Beretta-Piccoli, Benedetta, Schramm, Christoph, Kleiner, David E., De Martin, Eleonora, Kullak-Ublick, Gerd A., Stirnimann, Guido, Devarbhavi, Harshad, Vierling, John M., Manns, Michael P., Sebode, Marcial, Londoño, Maria Carlota, Avigan, Mark, Robles-Diaz, Mercedes, García-Cortes, Miren, Atallah, Edmond, Heneghan, Michael, Chalasani, Naga, Trivedi, Palak J., Hayashi, Paul H., Taubert, Richard, Fontana, Robert J., Weber, Sabine, Oo, Ye Htun, Zen, Yoh, Licata, Anna, Lucena, M Isabel, Mieli-Vergani, Giorgina, Vergani, Diego, Björnsson, Einar S.·2023·Journal of Hepatology
DOI 10.1016/j.jhep.2023.04.033PMC PMC10735171
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Abstract

Drug-induced liver injury (DILI) can mimic almost all other liver disorders. A phenotype increasingly ascribed to drugs is autoimmune-like hepatitis (ALH). This article summarises the major topics discussed at a joint International Conference held between the Drug-Induced Liver Injury consortium and the International Autoimmune Hepatitis Group. DI-ALH is a liver injury with laboratory and/or histological features that may be indistinguishable from those of autoimmune hepatitis (AIH). Previous studies have revealed that patients with DI-ALH and those with idiopathic AIH have very similar clinical, biochemical, immunological and histological features. Differentiating DI-ALH from AIH is important as patients with DI-ALH rarely require long-term immunosuppression and the condition often resolves spontaneously after withdrawal of the implicated drug, whereas patients with AIH mostly require long-term immunosuppression. Therefore, revision of the diagnosis on long-term follow-up may be necessary in some cases. More than 40 different drugs including nitrofurantoin, methyldopa, hydralazine, minocycline, infliximab, herbal and dietary supplements (such as Khat and Tinospora cordifolia) have been implicated in DI-ALH. Understanding of DI-ALH is limited by the lack of specific markers of the disease that could allow for a precise diagnosis, while there is similarly no single feature which is diagnostic of AIH. We propose a management algorithm for patients with liver injury and an autoimmune phenotype. There is an urgent need to prospectively evaluate patients with DI-ALH systematically to enable definitive characterisation of this condition.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This expert opinion meeting report standardizes the term drug-induced autoimmune-like hepatitis (DI-ALH) for a DILI phenotype that can be clinically, biochemically, immunologically, and histologically indistinguishable from idiopathic autoimmune hepatitis (AIH). It summarizes current evidence on implicated drugs, diagnosis, management, and research gaps, and proposes a management algorithm while emphasizing the need for prospective studies and better biomarkers.

Key findings

  • DI-ALH is a DILI phenotype with laboratory and/or histological autoimmune features; more than 40 agents have been implicated, including nitrofurantoin, methyldopa, hydralazine, minocycline, infliximab, and herbal/dietary supplements such as Khat and *Tinospora cordifolia*.
  • DI-ALH usually resolves after drug withdrawal and rarely requires long-term immunosuppression, unlike AIH, but relapse risk may increase over time: in Spanish and Latin-American registries, relapse probability was 17% at 6 months and 50% after 4 years of follow-up after remission.
  • Among DILI cohorts, 3–8.8% can be classified as DI-ALH; among 261 patients with AIH, 24 (9.2%) were retrospectively diagnosed as DI-ALH. In the Spanish DILI Registry, 1.2% of patients had two DILI episodes caused by different drugs and were more likely to present with autoimmune features in the second episode.
  • Checkpoint inhibitor-induced liver injury and SARS-CoV-2 vaccine-associated autoimmune-like hepatitis are discussed as emerging contexts; for example, 94% of ChILI cases had normal IgG, and ANA/ASMA positivity was more common in AIH (84%) than ChILI (32%).

Methods

  • Design: expert opinion meeting report from a joint International Conference between the Drug-Induced Liver Injury consortium and the International Autoimmune Hepatitis Group, held in March 2022 in Nerja, Spain, and endorsed by EASL.
  • Data: no new primary study data; the report synthesizes published literature, case series, registry findings, and expert discussion, including tables of drugs, autoantibody prevalence, and a proposed management algorithm.
  • Analysis: narrative expert consensus on nomenclature, diagnosis, management, natural history, drug development implications, and future research priorities.

Limitations

  • The paper states that DI-ALH is poorly characterized, lacks specific diagnostic markers, and has no single diagnostic feature for AIH; management evidence is scarce and comes mainly from retrospective studies, case reports, or expert opinion.
  • The paper states that there are no predictive markers identifying patients who will develop acute liver failure or chronic injury, and that prospective evaluation of DI-ALH is urgently needed.
  • Evident from the text: this is an expert consensus/meeting report rather than a systematic review or primary prospective study, so recommendations and prevalence estimates depend on heterogeneous published cohorts and registry data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jhep.2023.04.033

Cites

87 of 87 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

2 of 151 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    The lack of reliable diagnostic biomarkers and an evidence-based treatment paradigm has resulted in limited guidance on how to manage this aspect of DILI.

    “The lack of reliable diagnostic biomarkers and an evidence-based treatment paradigm has resulted in limited guidance on how to manage this aspect of DILI.2,25–27”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [2] 2019, EASL clinical practice guidelines: drug-induced liver injury, J Hepatol source
    • cites [25] Devarbhavi, 2021, Drug-induced liver injury: asia pacific association of study of liver consensus guidelines, Hepatol Int source
    • cites [26] Chalasani, 2021, Practice parameters committee of the American College of Gastroenterology. ACG clinical guideline: diagnosis and management of idiosyncratic drug-induced liver injury, Am J Gastroenterol source
    • cites [27] Fontana, 2023, AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury, Hepatology source

      The DILI biomarkers section says no objective, reliable laboratory test confirms a suspect drug. The Introduction describes patient-management recommendations as expert-opinion based, and the medical-management section notes a lack of controlled trials for some treatments. However, the paper provides management recommendations, so it does not establish the claim that guidance on managing DILI is limited. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    The term "immune-mediated DILI" is associated with many drugs that are not associated with well recognised autoimmune features.

    “The term “immune-mediated DILI” is also associated with many drugs that are not associated with well recognised autoimmune features.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [19] Weiler-Normann, 2011, Drug induced liver injury and its relationship to autoimmune hepatitis, J Hepatol source
    • cites [22] Liu, 2002, Immune-mediated drug-induced liver disease, Clin Liver Dis source
    • cites [23] Vuppalanchi, 2012, Clinical significance of serum autoantibodies in patients with NAFLD: results from the nonalcoholic steatohepatitis clinical research network, Hepatol Int source
  • Premisenone given

    Idiosyncratic DILI can, albeit rarely, manifest with clinical, biochemical, immunological, and histological features resembling the phenotype of AIH.

    “Since idiosyncratic DILI can, albeit rarely, manifest with clinical, biochemical, immunological, and histological features resembling the phenotype of AIH, the two entities must be distinguished.”
    Quote in the paperSubstantial claim
  • Premisenone given

    DI-ALH often resolves spontaneously after withdrawal of the implicated drug.

    “the condition often resolves spontaneously after withdrawal of the implicated drug”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Checkpoint inhibitor therapy-related cholangiopathy with progression to bile duct loss has been reported.

    “though checkpoint inhibitor therapy-related cholangiopathy with progression to bile duct loss has also been reported.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Berry, 2023, Immune checkpoint inhibitor-related cholangiopathy: novel clinicopathological description of a multi-centre cohort, Liver Int source
  • It may state two separate claims as one. 49
  • Probably not a substantial claim. 40

  • It may state two separate claims as one.

    Premisecitation

    Histology showed lobular hepatitis (76%) and portal hepatitis (17%), with fibrosis being more prominent in the latter, which favoured the diagnosis of DI-ALH rather than AIH, despite the fact that 82% of patients had typical or probable AIH on simplified IAIHG scoring and that 92% of patients had likely or possible AIH based on the ERN histology system.

    “Histology showed lobular hepatitis (76%) and portal hepatitis (17%), with fibrosis being more prominent in the latter, which favoured the diagnosis of DI-ALH rather than AIH, despite the fact that 82% of patients had typical or probable AIH on simplified IAIHG scoring46 and that 92% of patients had likely or possible AIH based on the ERN histology system.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [46] Hennes, 2008, Simplified criteria for the diagnosis of autoimmune hepatitis, Hepatology source
    • cites [3] Lohse, 2022, Liver Int source

  • It may state two separate claims as one.

    Interpretationcitation

    Relapse of liver injury after a new dose of vaccine occurred in only 25% of cases, which challenges the causal relationship or reflects adaptation to the vaccine.

    “In contrast, relapse of liver injury after a new dose of vaccine occurred in only 25% of cases, which challenges the causal relationship or reflects adaptation to the vaccine.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Codoni, 2023, Histological and serological features of acute liver injury after SARS-CoV-2 vaccination, JHEP Rep source

  • Probably not a substantial claim. The paper may give no reason why it holds.

    Premisenone given

    AIH has a recognised high potential for chronicity or recurrence of hepatitis that requires long-term immunosuppressive therapy.

    “In contrast to a recognised high potential for chronicity or recurrence of hepatitis in AIH that requires long-term immunosuppressive therapy”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisenone given

    The pattern of injury in ChILI is hepatocellular in around 60% of cases.

    “The pattern of injury is hepatocellular in around 60% of cases”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    Idiosyncratic DILI affects only susceptible individuals and is less related to the drug dose.

    “Idiosyncratic DILI affects only susceptible individuals and is less related to the drug dose.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Hoofnagle, 2019, Drug-induced liver injury - types and phenotypes, N Engl J Med source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Shortly after vaccination campaigns started, the first case of possible AIH related to SARS-CoV-2 vaccination was published.

    “Shortly after vaccination campaigns started, the first case of possible AIH related to SARS-CoV-2 vaccination was published.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Bril, 2021, Autoimmune hepatitis developing after coronavirus disease 2019 (COVID-19) vaccine: causality or casualty?, J Hepatol source

  • It may state two separate claims as one.

    Premisecitation

    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.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [14] Björnsson, 2010, Drug-induced autoimmune hepatitis: clinical characteristics and prognosis, Hepatology source
    • cites [15] Andrade, 2016, Characterizing drug-induced liver injury with autoimmune features, Clin Gastroenterol Hepatol source
    • cites [19] Weiler-Normann, 2011, Drug induced liver injury and its relationship to autoimmune hepatitis, J Hepatol source
    • cites [21] Björnsson, 2022, Setting up criteria for drug-induced autoimmune-like hepatitis through a systematic analysis of published report, Hepatol Commun source
    • cites [24] de Boer, 2017, Features of autoimmune hepatitis in patients with drug-induced liver injury, Clin Gastroenterol Hepatol source

  • Probably not a substantial claim. The paper may give no reason why it holds.

    Premisenone given

    Patients with AIH mostly require long-term immunosuppression.

    “patients with AIH mostly require long-term immunosuppression”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Idiopathic AIH is characterised by a chronic progressive course resulting in fibrosis, liver failure and death if left untreated.

    “Idiopathic AIH is characterised by a chronic progressive course resulting in fibrosis, liver failure and death if left untreated.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Kirstein, 2015, Prediction of short- and long-term outcome in patients with autoimmune hepatitis, Hepatology source

  • Probably not a substantial claim. It may state two separate claims as one.

    Premisereasoning

    With high rates of lasting resolution of liver injury in most patients with ALH after drug discontinuation, optimal management and requirement of immunosuppressants for this condition have yet to be elucidated.

    “With high rates of lasting resolution of liver injury in most patients with ALH after drug discontinuation, optimal management and requirement of immunosuppressants for this condition have yet to be elucidated.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper may give no reason why it holds.

    Premisenone given

    Currently, there are no predictive markers that identify individuals with ALH who may develop ALF or chronic injury.

    “Currently, there are no predictive markers that identify such individuals.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    ChILI is accounting for an increasing proportion of recent DILI cohort studies.

    “Checkpoint inhibitor-induced liver injury (ChILI) is accounting for an increasing proportion of recent DILI cohort studies.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10] Björnsson, 2023, A new framework for advancing in drug-induced liver injury research. The Prospective European DILI Registry, Liver Int source
    • cites [38] Atallah, 2022, Prescription event monitoring of checkpoint inhibitor-induced liver injury and outcomes of rechallenge: a 10-year experience, EMJ Hepatol source

  • It may state two separate claims as one.

    Premisecitation

    Overall, 75% tested positive for ANA, while polyreactive IgG with reactivity against BSA/HIP1R was detected in almost half of patients.

    “Overall, 75% tested positive for ANA, while polyreactive IgG with reactivity against BSA/HIP1R (a new biomarker for AIH with a reportedly higher specificity than conventional autoantibodies) was detected in almost half of patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] Codoni, 2023, Histological and serological features of acute liver injury after SARS-CoV-2 vaccination, JHEP Rep source

  • It may state two separate claims as one.

    Premisenone given

    The vast majority of cases did not experience a relapse of liver injury, although follow-up was not prolonged in many cases.

    “The vast majority of cases did not experience a relapse of liver injury, although follow-up was not prolonged in many cases.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    In genetically predisposed individuals, environmental factors, such as infections, are thought to initiate the self-perpetuating disease, but a definitive trigger has not been identified.

    “In genetically predisposed individuals, environmental factors, such as infections, are thought to initiate the self-perpetuating disease, but a definitive trigger has not been identified.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [5] Mack, 2020, Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American association for the study of liver diseases, Hepatology source
    • cites [6] 2015, EASL clinical practice guidelines: autoimmune hepatitis, J Hepatol source
    • cites [12] Lammert, 2021, Environmental risk factors are associated with autoimmune hepatitis, Liver Int source

  • Probably not a substantial claim.

    Premisenone given

    Diagnosis of AIH is based on clinical, biochemical, serological and histological features.

    “Diagnosis of AIH is based on clinical, biochemical, serological and histological features.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Premisenone given

    There is compelling evidence that idiosyncratic DILI is typically an immune-mediated disorder.

    “There is compelling evidence that idiosyncratic DILI is typically an immune-mediated disorder.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may state two separate claims as one.

    Premisenone given

    Some patients with ALH may develop acute liver failure (ALF) or clinically significant chronic injury for whom long-term clinical follow-up may be warranted.

    “Nonetheless, some patients with ALH may develop acute liver failure (ALF) or clinically significant chronic injury for whom long-term clinical follow-up may be warranted.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationcitation

    The temporal relationship between vaccination and the appearance of the liver injury, and the fact that hepatitis was diagnosed after the 2nd vaccine dose in the majority of cases, suggested causality.

    “The temporal relationship between vaccination and the appearance of the liver injury, and the fact that hepatitis was diagnosed after the 2nd vaccine dose in the majority of cases8 suggested causality.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Codoni, 2023, Histological and serological features of acute liver injury after SARS-CoV-2 vaccination, JHEP Rep source

  • Probably not a substantial claim. It may state two separate claims as one.

    Premisereasoning

    Nomenclature and diagnostic criteria for DI-ALH lack specificity.

    “Nomenclature and diagnostic criteria for DI-ALH lack specificity.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Premisecitation

    Several case reports and case series followed, with an autoimmune phenotype observed in all cases.

    “Several case reports and case series followed, with an autoimmune phenotype observed in all cases.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Efe, 2022, Liver injury after SARS-CoV-2 vaccination: features of immune-mediated hepatitis, role of corticosteroid therapy and outcome, Hepatology source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Other reported causative agents of DI-ALH include interferon, statins, methylprednisolone, adalimumab, imatinib, diclofenac, Tinospora cordifolia and Khat.

    “Other reported causative agents of DI-ALH include interferon, statins, methylprednisolone, adalimumab, imatinib, diclofenac, Tinospora cordifolia and Khat.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Björnsson, 2022, Setting up criteria for drug-induced autoimmune-like hepatitis through a systematic analysis of published report, Hepatol Commun source

  • It may state two separate claims as one.

    Premisecitation

    Most affected patients were females (63%) and liver disease was diagnosed a median of 15 days after vaccination.

    “Most affected patients were females (63%) and liver disease was diagnosed a median of 15 days after vaccination.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Efe, 2022, Liver injury after SARS-CoV-2 vaccination: features of immune-mediated hepatitis, role of corticosteroid therapy and outcome, Hepatology source

  • It may state two separate claims as one.

    Premisenone given

    The liver injury was symptomatic in most patients, with a single patient evolving to ALF requiring a liver transplantation.

    “The liver injury was symptomatic in most patients, with a single patient evolving to ALF requiring a liver transplantation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper may give no reason why it holds.

    Premisenone given

    There is no single feature which is diagnostic of AIH.

    “there is similarly no single feature which is diagnostic of AIH”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    The majority of DI-ALH cases present with an acute hepatocellular injury pattern but in rare instances a cholestatic pattern is observed.

    “The majority of DI-ALH cases present with an acute hepatocellular injury pattern but in rare instances a cholestatic pattern is observed.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Björnsson, 2022, Setting up criteria for drug-induced autoimmune-like hepatitis through a systematic analysis of published report, Hepatol Commun source

  • Probably not a substantial claim.

    Premisecitation

    In a recent study, five criteria were proposed to define DI-ALH based on cases of suspected DI-ALH published in the literature.

    “In a recent study,21 five criteria were proposed to define DI-ALH based on cases of suspected DI-ALH published in the literature.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Björnsson, 2022, Setting up criteria for drug-induced autoimmune-like hepatitis through a systematic analysis of published report, Hepatol Commun source

  • It may state two separate claims as one.

    Premisecitation

    Liver biopsy can improve diagnostic certainty as well as avoid unnecessary immunosuppression in a proportion of cases.

    “Liver biopsy can improve diagnostic certainty as well as avoid unnecessary immunosuppression in a proportion of cases.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisenone given

    More than 40 different drugs have been implicated in DI-ALH.

    “More than 40 different drugs including nitrofurantoin, methyldopa, hydralazine, minocycline, infliximab, herbal and dietary supplements (such as Khat and Tinospora cordifolia) have been implicated in DI-ALH.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    ANA and ASMA positivity was detected in both ChILI and AIH, but was more common in AIH (84%) than in ChILI (32%).

    “ANA and ASMA positivity was detected in both conditions, but was more common in AIH (84%) than in ChILI (32%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Riveiro-Barciela, 2020, Immune-related hepatitis related to checkpoint inhibitors: clinical and prognostic factors, Liver Int source

  • It may state two separate claims as one.

    Premisecitation

    ALH events are characterised by histological features highly overlapping with idiopathic AIH and often associated with serum liver autoantibodies and elevated IgG levels.

    “ALH events are characterised by histological features highly overlapping with ‘idiopathic’ (classical) AIH and often associated with the presence of serum liver autoantibodies and elevated IgG levels.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Lohse, 2022, Liver Int source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    AIH is thought to be caused by a loss of immunological tolerance in liver tissue resulting in immune-mediated damage of the hepatic parenchyma.

    “AIH is thought to be caused by a loss of immunological tolerance in liver tissue resulting in immune-mediated damage of the hepatic parenchyma.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [6] 2015, EASL clinical practice guidelines: autoimmune hepatitis, J Hepatol source
    • cites [11] Pape, 2022, Systematic review of response criteria and endpoints in autoimmune hepatitis by the International Autoimmune Hepatitis Group, J Hepatol source
    • cites [12] Lammert, 2021, Environmental risk factors are associated with autoimmune hepatitis, Liver Int source

  • It may state two separate claims as one.

    Premisecitation

    ChILI shows less severe confluent necrosis and plasma cell infiltration, fewer CD4+ and more CD8+ infiltrating lymphocytes than classical AIH on liver biopsies.

    “ChILI shows less severe confluent necrosis and plasma cell infiltration, fewer CD4+ and more CD8+ infiltrating lymphocytes than classical AIH on liver biopsies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Zen, 2018, Hepatotoxicity of immune checkpoint inhibitors: a histology study of seven cases in comparison with autoimmune hepatitis and idiosyncratic drug-induced liver injury, Mod Pathol source

  • It may state two separate claims as one.

    Premisecitation

    A frequent challenge is to differentiate the clinical presentation of DILI from AIH, since there is no differentiating biomarker between the two entities.

    “A frequent challenge is to differentiate the clinical presentation of DILI from AIH, since there is no differentiating biomarker between the two entities.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] Castiella, 2014, Drug-induced autoimmune liver disease: a diagnostic dilemma of an increasingly reported disease, World J Hepatol source

  • It may state two separate claims as one.

    Premisenone given

    The majority of patients received immunosuppression with steroids, and liver enzymes normalised in two-thirds after 6 months.

    “The majority of patients received immunosuppression with steroids, and liver enzymes normalised in two-thirds after 6 months.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    Steroids were administered in 59% of patients before performing a liver biopsy according to clinical guidelines, but some patients' conditions improved without the need for immunosuppression.

    “Consistent with current practice, steroids were administered in 59% of patients before performing a liver biopsy according to clinical guidelines, but some patients’ conditions improved without the need for immunosuppression.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [38] Atallah, 2022, Prescription event monitoring of checkpoint inhibitor-induced liver injury and outcomes of rechallenge: a 10-year experience, EMJ Hepatol source
    • cites [43] De Martin, 2018, Characterization of liver injury induced by cancer immunotherapy using immune checkpoint inhibitors, J Hepatol source

  • It may state two separate claims as one.

    Premisecitation

    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”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] Björnsson, 2010, Drug-induced autoimmune hepatitis: clinical characteristics and prognosis, Hepatology source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    A revised electronic version of RUCAM was developed, coined RECAM, using data from two large prospective DILI registries, the DILIN and the Spanish DILI Registry.

    “Recently, a revised electronic version of RUCAM was developed, coined the Revised Electronic Causality Assessment Method (RECAM), using data from two large prospective DILI registries, the DILIN (Drug-Induced Liver Injury Network) and the Spanish DILI Registry.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] Hayashi, 2022, A revised electronic version of RUCAM for the diagnosis of DILI, Hepatology source

  • It may state two separate claims as one.

    Premisecitation

    In a retrospective longitudinal cohort of patients with drug-induced jaundice (n = 685), 3.4% (n = 23) of patients were hospitalised (during a mean follow-up of 10 years) of whom 22% (n = 5) developed AIH at 1.5 months to 6 years from the initial event and another five developed cryptogenic cirrhosis.

    “In a retrospective longitudinal cohort of patients with drug-induced jaundice (n = 685), 3.4% (n = 23) of patients were hospitalised (during a mean follow-up of 10 years) of whom 22% (n = 5) developed AIH at 1.5 months to 6 years from the initial event and another five developed cryptogenic cirrhosis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Björnsson, 2009, The long-term follow-up after idiosyncratic drug-induced liver injury with jaundice, J Hepatol source

  • It may state two separate claims as one.

    Premisecitation

    RECAM seems to lead to improved case identification, earlier diagnosis, and medical management of DILI cases.

    “RECAM seems to lead to improved case identification, earlier diagnosis, and medical management of DILI cases.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] Hayashi, 2022, A revised electronic version of RUCAM for the diagnosis of DILI, Hepatology source

  • It may state two separate claims as one.

    Premisenone given

    This study was limited by less than strict criteria for DI-ALH and the fact that the implicated drugs were not definitively associated with DILI with autoimmune features.

    “This study was limited by less than strict criteria for DI-ALH and the fact that the implicated drugs were not definitively associated with DILI with autoimmune features.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisenone given

    The spectrum of injury is variable and plasma cells are only increased in two-thirds of biopsies, while either an acute- or chronic-hepatitis pattern of injury can develop in DI-ALH.

    “The spectrum of injury is variable and plasma cells are only increased in two-thirds of biopsies, while either an acute- or chronic-hepatitis pattern of injury can develop (Fig. 1).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    Studies comparing DILI with AIH have included DILI cases more broadly and have not focused on the comparison between AIH and DI-ALH.

    “Thus far, studies comparing DILI with AIH have included DILI cases more broadly and have not focused on the comparison between AIH and DI-ALH.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [61] Kleiner, 2014, Hepatic histological findings in suspected drug-induced liver injury: systematic evaluation and clinical associations, Hepatology source

  • It may state two separate claims as one.

    Premisecitation

    Histological features of AIH are infiltration with lymphocytes and plasma cells, interface hepatitis, rosette formation and emperipolesis.

    “Histological features of AIH are infiltration with lymphocytes and plasma cells, interface hepatitis, rosette formation and emperipolesis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [60] de Boer, 2015, Assessment of the histopathological key features in autoimmune hepatitis, Histopathology source

  • Probably not a substantial claim.

    Premisenone given

    It is not clear if the results of histology, lack of improvement of liver tests after stopping the implicated drug or both should be used as the indication for corticosteroids in patients with DI-ALH.

    “It is not clear if the results of histology, lack of improvement of liver tests after stopping the implicated drug or both should be used as the indication for corticosteroids in patients with DI-ALH.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Premisenone given

    The parenchyma is also inflamed, and variable degrees of confluent necrosis (e.g., perivenular or panacinar necrosis) can occur in DI-ALH.

    “The parenchyma is also inflamed, and variable degrees of confluent necrosis (e.g., perivenular or panacinar necrosis) can occur.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    According to the authors, polyreactive IgG might be a new marker that could facilitate diagnosis and help to preselect patients with liver disease for biopsy, because of higher specificity and overall accuracy than routine autoantibodies.

    “According to the authors, polyreactive lgG might be a new marker that could facilitate diagnosis and help to preselect patients with liver disease for biopsy, because of higher specificity and overall accuracy than routine autoantibodies (e.g. ANA, SMA, and anti-liver-kidney microsomal antibodies).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] Taubert, 2022, Quantification of polyreactive immunoglobulin G facilitates the diagnosis of autoimmune hepatitis, Hepatology source

  • It may state two separate claims as one.

    Premisecitation

    Lammert et al. demonstrated that AIH was characterised by a group of both IgG and IgM autoantibodies while DI-ALH was only characterised by IgM, which could be used as a feature to distinguish DI-ALH from AIH.

    “Lammert et al., demonstrated that AIH was characterised by a group of both IgG and IgM autoantibodies while DI-ALH was only characterised by IgM, which could be used as a feature to distinguish DI-ALH from AIH.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Garcia-Cortes, 2011, Causality assessment methods in drug induced liver injury: strengths and weaknesses, J Hepatol source

  • It may state two separate claims as one.

    Interpretationcitation

    The retrospective cohort findings highlight the challenges of distinguishing between DI-ALH and AIH, as well as providing evidence for the potential chronicity of DI-ALH and therefore the need for long-term follow-up.

    “This highlights the challenges of distinguishing between DI-ALH and AIH, as well as providing evidence for the potential chronicity of DI-ALH and therefore the need for long-term follow-up.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Among the causality assessment methods used for the diagnosis of DILI, RUCAM has previously been the most used in clinical research worldwide.

    “Among the causality assessment methods used for the diagnosis of DILI, Roussel Uclaf Causality Assessment Method (RUCAM) has previously been the most used in clinical research worldwide.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] Danan, 1993, Causality assessment of adverse reactions to drugs--I. A novel method based on the conclusions of international consensus meetings: application to drug-induced liver injuries, J Clin Epidemiol source

  • It may state two separate claims as one.

    Premisenone given

    Information is scarce on the management of DI-ALH and comes mainly from retrospective studies.

    “Information is scarce on the management of DI-ALH and comes mainly from retrospective studies.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Premisenone given

    Liver biopsy is useful for confirmation of AIH-like histology and exclusion of other potential diagnoses (e.g., steatohepatitis).

    “Liver biopsy is useful for confirmation of AIH-like histology and exclusion of other potential diagnoses (e.g., steatohepatitis).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    The original IAIHG scoring system was initially developed to define cohorts of patients with AIH for clinical trials and in difficult cases, but the new simplified version is more applicable to clinical practice.

    “The original IAIHG scoring system59 was initially developed to define cohorts of patients with AIH for clinical trials and in difficult cases, but the new simplified version is more applicable to clinical practice.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [59] Alvarez, 1999, International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis, J Hepatol source
    • cites [60] de Boer, 2015, Assessment of the histopathological key features in autoimmune hepatitis, Histopathology source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Concerns have been raised regarding RUCAM's poor reliability, validity and the lack of clinical evidence for the domain criteria.

    “However, concerns have been raised regarding its poor reliability, validity and the lack of clinical evidence for the domain criteria.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [63] Garcia-Cortes, 2011, Causality assessment methods in drug induced liver injury: strengths and weaknesses, J Hepatol source

  • It may state two separate claims as one.

    Premisecitation

    The specificity of emperipolesis and rosette formation for AIH has been questioned and might reflect disease severity rather than aetiology of liver injury.

    “The specificity of emperipolesis and rosette formation for AIH has been questioned and might reflect disease severity rather than aetiology of liver injury.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Lohse, 2022, Liver Int source

  • It may state two separate claims as one.

    Interpretationcitation

    Differentiating DI-ALH from AIH is crucial since most published studies suggest that DI-ALH often resolves spontaneously after withdrawal of the causative drug and affected patients rarely require long-term immunosuppression.

    “Differentiating DI-ALH from AIH is crucial since most published studies suggest that DI-ALH often resolves spontaneously after withdrawal of the causative drug and affected patients rarely require long-term immunosuppression.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] de Boer, 2017, Features of autoimmune hepatitis in patients with drug-induced liver injury, Clin Gastroenterol Hepatol source

  • It may state two separate claims as one.

    Interpretationcitation

    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.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [14] Björnsson, 2010, Drug-induced autoimmune hepatitis: clinical characteristics and prognosis, Hepatology source
    • cites [16] Suzuki, 2011, The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury, Hepatology source
    • cites [48] Febres-Aldana, 2019, Liver fibrosis helps to distinguish autoimmune hepatitis from DILI with autoimmune features: a review of twenty cases, J Clin Transl Hepatol source

  • Probably not a substantial claim.

    Premisenone given

    RECAM, like RUCAM, was not designed to consider specific emerging phenotypes like DI-ALH.

    “However, RECAM, like RUCAM, was not designed to consider specific emerging phenotypes like DI-ALH.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Premisecitation

    Resolution may not appear immediately and ongoing or even worsening liver injury can occur despite the withdrawal of the implicated drug.

    “Resolution may not appear immediately and ongoing or even worsening liver injury can occur despite the withdrawal of the implicated drug.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [24] de Boer, 2017, Features of autoimmune hepatitis in patients with drug-induced liver injury, Clin Gastroenterol Hepatol source
    • cites [50] Björnsson, 2022, Infliximab-induced liver injury: clinical phenotypes, autoimmunity and the role of corticosteroid treatment, J Hepatol source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisenone given

    It is not clear how long the clinician should wait for improvement and this is currently based on clinical judgment.

    “It is not clear how long the clinician should wait for improvement and this is currently based on clinical judgment.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    In another study by Taubert et al., protein microarrays were used to identify polyreactive IgG, which is elevated in AIH.

    “In another study by Taubert et al., protein microarrays were used to identify polyreactive IgG, which is elevated in AIH.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [66] Taubert, 2022, Quantification of polyreactive immunoglobulin G facilitates the diagnosis of autoimmune hepatitis, Hepatology source

  • Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.

    Premisenone given

    Delays in withdrawal of the suspected drug may impact both the severity of injury and responsiveness to therapy.

    “Delays in withdrawal of the suspected drug may impact both the severity of injury and responsiveness to therapy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Different authors agree that further work is still required to determine the optimal steroid induction protocol in patients with severe AIH.

    “Different authors agree that further work is still required to determine the optimal steroid induction protocol in patients with severe AIH.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Liberal, 2021, Acute severe autoimmune hepatitis - timing for steroids and role of other immunosuppressive agents, J Hepatol source

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.

    Interpretationnone given

    DI-ALH as a clinical phenotype is poorly characterised.

    “In summary, DI-ALH as a clinical phenotype is poorly characterised.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: There is a lack of data and specific biomarkers to characterise and discriminate DILI vs. AIH vs. DI-ALH.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Premisenone given

    Rechallenge is currently the strongest proof of causality in the adjudication process of suspected DILI.

    “Rechallenge (re-administration of a drug suspected to have caused DILI) is currently the strongest proof of causality in the adjudication process of suspected DILI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.

    Premisenone given

    A correct diagnosis of the (auto)immune phenotype of DILI is necessary to define the precise epidemiology of DI-ALH.

    “To define the precise epidemiology of DI-ALH, a correct diagnosis of the (auto)immune phenotype of DILI is necessary.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Premisenone given

    Information on the morphologic evaluation of liver biopsy can be augmented by using immunohistochemical and molecular techniques.

    “The experts agree that information on the morphologic evaluation of liver biopsy can be augmented by using immunohistochemical and molecular techniques.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim.

    Premisenone given

    A current identified gap in the management of DI-ALH is which patients require immunosuppression.

    “The current identified gaps in the management of DI-AILH are: 1) which patients require immunosuppression, 2) standardisation of treatment regimens (e.g. dose and duration of therapy) in the event immunosuppression is administered, and 3) when to withdraw therapy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. It may state two separate claims as one.

    Interpretationreasoning

    Labelling cases as potential DI-ALH in clinical trials may trigger follow-up actions, including determining liver-specific autoantibodies in patients with elevated aminotransferases, administering steroids according to current recommendations for treatment of AIH, and long-term follow-up of study participants to monitor for possible flares of AIH in either the presence or absence of study drug.

    “Labelling cases as potential DI-ALH in clinical trials may trigger follow-up actions, including: determining liver-specific autoantibodies in patients with elevated aminotransferases, administering steroids according to current recommendations for treatment of AIH, and long-term follow-up of study participants to monitor for possible flares of AIH in either the presence or absence of study drug.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim.

    Premisenone given

    A current identified gap in the management of DI-ALH is when to withdraw therapy.

    “The current identified gaps in the management of DI-AILH are: 1) which patients require immunosuppression, 2) standardisation of treatment regimens (e.g. dose and duration of therapy) in the event immunosuppression is administered, and 3) when to withdraw therapy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. It may state two separate claims as one.

    Premisereasoning

    While different studies have reported distinct protocols and doses of steroids in AIH, there are still some uncertainties about the optimal management of these patients.

    “While different studies have reported distinct protocols and doses of steroids in AIH, there are still some uncertainties about the optimal management of these patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Premisecitation

    A much better understanding of the mechanisms underlying DILI and DI-ALH is essential to design improved predictive models.

    “A much better understanding of the mechanisms underlying DILI and DI-ALH is essential to design improved predictive models.82”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [82] Regev, 2014, Drug-induced liver injury and drug development: industry perspective, Semin Liver Dis source

  • Probably not a substantial claim.

    Premisenone given

    A current identified gap in the management of DI-ALH is the standardisation of treatment regimens (dose and duration) when immunosuppression is administered.

    “The current identified gaps in the management of DI-AILH are: 1) which patients require immunosuppression, 2) standardisation of treatment regimens (e.g. dose and duration of therapy) in the event immunosuppression is administered, and 3) when to withdraw therapy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In a recent study of patients with DI-ALH associated with infliximab, the median dose of prednisolone used was 30 mg, or 40 mg for patients with jaundice.

    “In a recent study of patients with DI-ALH associated with infliximab, the median dose of prednisolone used was 30 mg, or 40 mg for patients with jaundice.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Björnsson, 2022, Infliximab-induced liver injury: clinical phenotypes, autoimmunity and the role of corticosteroid treatment, J Hepatol source

  • It may state two separate claims as one.

    Premisecitation

    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”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [14] Björnsson, 2010, Drug-induced autoimmune hepatitis: clinical characteristics and prognosis, Hepatology source
    • cites [17] Björnsson, 2017, Drug-induced autoimmune hepatitis: response to corticosteroids and lack of relapse after cessation of steroids, Clin Gastroenterol Hepatol source
    • cites [34] Rodrigues, 2015, Autoimmune hepatitis and anti-tumor necrosis factor alpha therapy: a single center report of 8 cases, World J Gastroenterol source

  • It may state two separate claims as one.

    Interpretationcitation

    DI-ALH presents as a self-limited phenotype that resolves or becomes quiescent when the drug is removed, but in some cases liver injury progresses to chronicity and a self-perpetuating autoimmune liver disease ensues.

    “Thus, DI-AHL presents as a “self-limited” phenotype that resolves or becomes quiescent when the drug is removed, but in some cases, liver injury does progress to chronicity and a “self-perpetuating” autoimmune liver disease ensues (Fig. 2).22,51,52”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [22] Liu, 2002, Immune-mediated drug-induced liver disease, Clin Liver Dis source
    • cites [51] García-Cortés, 2023, Clinical presentation, causative drugs, and outcome of patients with autoimmune features in the Spanish DILI Regsitry and the Latin American DILI Network, Liver Int source
    • cites [52] Björnsson, 2009, The long-term follow-up after idiosyncratic drug-induced liver injury with jaundice, J Hepatol source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In the case of DI-ALH, steroid dosage is usually determined based on the principal investigator's personal experience.

    “In the case of DI-ALH, steroid dosage is usually determined based on the principal investigator’s personal experience.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] Hu, 2019, Corticosteroid therapy in drug-induced liver injury: pros and cons, J Dig Dis source

  • It may state two separate claims as one.

    Premisecitation

    Drug rechallenge in DILI cases is potentially dangerous and is associated with risk of death or requirement for liver transplant.

    “However, drug rechallenge in DILI cases is potentially dangerous2,75 and is associated with risk of death or requirement for liver transplant.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [2] 2019, EASL clinical practice guidelines: drug-induced liver injury, J Hepatol source
    • cites [75] Andrade, 2009, Rechallenge in drug-induced liver injury: the attractive hazard, Expert Opin Drug Saf source
    • cites [15] Andrade, 2016, Characterizing drug-induced liver injury with autoimmune features, Clin Gastroenterol Hepatol source
    • cites [76] Hunt, 2017, Drug rechallenge following drug-induced liver injury, Hepatology source
78 of 78

  • The paper relies on this without support.

    The Spanish DILI Registry algorithm has not been replicated, and it is unknown if it applies to DI-ALH.

    “However, this has not been replicated and it is unknown if this algorithm applies to DI-ALH.”

  • The paper relies on this without support.

    There is a lack of data and specific biomarkers to characterise and discriminate DILI vs. AIH vs. DI-ALH.

    “There is a lack of data and specific biomarkers to characterise and discriminate DILI vs. AIH vs. DI-ALH.”

  • The paper relies on this without support.

    Testing for carriage of particular HLA alleles in selected cases will assist in the diagnosis of DILI or AIH.

    “Testing for carriage of particular HLA alleles in selected cases will assist in the diagnosis of DILI or AIH.”

  • The paper relies on this without support.

    Progression of DI-ALH to ALF is uncommon.

    “since the progression of DI-ALH to ALF is uncommon”

  • The paper relies on this without support.

    There are no biomarkers predictive of disease progression in DI-ALH.

    “and there are no biomarkers predictive of disease progression”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Lammert study is cited as a different paper

    Minor

    The text attributes this finding to Lammert et al. and cites reference 63, but reference 63 lists Garcia-Cortes et al. The Lammert et al. study is listed as reference 65.

1 of 1

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Metadata

Authors
Andrade, R. J., Aithal, G. P., de Boer, Y. S., Liberal, R., Gerbes, A., Regev, A., Terziroli Beretta-Piccoli, B., Schramm, C., Kleiner, D. E., De Martin, E., Kullak-Ublick, G. A., Stirnimann, G., Devarbhavi, H., Vierling, J. M., Manns, M. P., Sebode, M., Londoño, M. C., Avigan, M., Robles-Diaz, M., García-Cortes, M., Atallah, E., Heneghan, M., Chalasani, N., Trivedi, P. J., Hayashi, P. H., Taubert, R., Fontana, R. J., Weber, S., Oo, Y. H., Zen, Y., Licata, A., Lucena, M. I., Mieli-Vergani, G., Vergani, D., & Björnsson, E. S.
Affiliations
  • Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES)
  • Nottingham University Hospitals NHS Trust (GB)
  • Amsterdam University Medical Centers (NL)
  • Universidade do Porto (PT)
  • LMU Klinikum (DE)
  • Eli Lilly (United States) (US)
  • University Medical Center Hamburg-Eppendorf (DE)
  • National Institutes of Health (US)
  • Novartis (Switzerland) (CH)
  • University of Bern (CH)
  • St.John's Medical College Hospital (IN)
  • Baylor College of Medicine (US)
  • Medizinische Hochschule Hannover (DE)
  • United States Food and Drug Administration (US)
  • King's College Hospital (GB)
  • Indiana University Health (US)
  • National Health Service (GB)
  • University of Michigan (US)
  • University Hospitals Birmingham NHS Foundation Trust (GB)
  • University of Palermo (IT)
  • Spanish Clinical Research Network (ES)
  • King's College London (GB)
Corresponding author
  • Andrade, Raúl J.
  • Lucena, M Isabel
ORCID
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2023-09
Volume
79
Issue
3
Pages
853-866
ISSN
0168-8278 (ISSN-L)
DOI
10.1016/j.jhep.2023.04.033
PMC
PMC10735171
OpenAlex
W4376131204
Cited by
166
References
89
Citations by year
2026: 42 · 2025: 65 · 2024: 46 · 2023: 13
FWCI
5.88
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Hepatology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Repository@Nottingham (University of Nottingham) (publishedVersion, other-oa)
  • University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by-nc-nd)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • PubMed Central (acceptedVersion, cc-by-nc-nd)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by-nc-nd)
  • Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc-nd)
  • Repositorio Institucional de la Universidad de Málaga (University of Málaga) (submittedVersion, cc-by)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc-nd)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc-nd)
  • Open Access CRIS of the University of Bern
  • Zurich Open Repository and Archive (University of Zurich)
Funders
  • European Regional Development Fund
  • European Cooperation in Science and Technology (CA-17112)
  • Sir Jules Thorn Charitable Trust
  • Universidad de Málaga
  • Carlos III Health Institute (PT20/00127)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
  • Health Sciences › Medicine › Rheumatology › IgG4-Related and Inflammatory Diseases
Keywords
drug-induced liver injury, autoimmune hepatitis, differential diagnosis, nomenclature, management algorithm, herbal and dietary supplements, nitrofurantoin, methyldopa, hydralazine, minocycline, infliximab, Tinospora cordifolia, khat, immunosuppression, histopathology
MeSH terms
Congresses as Topic, Humans, Nitrofurantoin, Hepatitis, Autoimmune, Chemical and Drug Induced Liver Injury

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