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. 2018 May 24;2(3):97-104.
doi: 10.1002/jgh3.12054. eCollection 2018 Jun.

Differential characteristics in drug-induced autoimmune hepatitis

Omar Yesid Martínez-Casas  1 , Gabriel Sebastián Díaz-Ramírez  1 , Juan Ignacio Marín-Zuluaga  2   3 , Octavio Muñoz-Maya  2   3 , Oscar Santos  2   3 , Jorge Hernando Donado-Gómez  2   4 , Juan Carlos Restrepo-Gutiérrez  2   3
Affiliations

Differential characteristics in drug-induced autoimmune hepatitis

Omar Yesid Martínez-Casas et al. JGH Open. .

Abstract

Background and aim: Drug-induced autoimmune hepatitis (DIAIH) is an adverse effect associated with several drugs that usually occurs acutely, with variable latency, and it may potentially be mortal. There are a few reports and studies about DIAIH.

Methods: This was an analytical study of a retrospective cohort of patients, discriminated according to idiopathic or drug-induced etiology, followed up for a 7-year period until 31 December 2016.

Results: A total of 190 patients were selected for the analysis, 12 (6.3%) with DIAIH. The two main drugs related to DIAIH were nitrofurantoin, n = 8 (67%), and NSAID, n = 2 (17%), constituting 84% of the cases. There were no significant differences in seropositivity between AIH with DIAIH in antinuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA) antibodies, with 82.6% versus 82.6% and 34% versus 16%, respectively. The fibrosis stages were similar, except for the F4 stage, in a greater proportion in AIH. None of the patients with DIAIH had cirrhosis or developed it during follow-up, but it was present in 42.1% of the AIH cases at diagnosis (P = 0.003). Biochemical remission with management was higher in DIAIH but not significant (91.7% vs 80.9%, P = 0.35). The definitive interruption of immunosuppression was successfully performed in 25% of those with DIAIH without relapses but was only possible in 2.8% in AIH (P < 0.001) with 32 cases of relapses.

Conclusion: DIAIH constitutes a minor proportion of AIH. The clinical and histological characteristics may be similar; DIAIH patients have a greater chance of having treatment suspended with a low risk of relapse, progression to cirrhosis, or need for liver transplant.

Keywords: autoimmune hepatitis; autoimmunity; drug‐induced liver injury; immunosuppression; prognosis.

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Figures

Figure 1
Figure 1
Scheme for the selection of patients. They could have more than one reason to be excluded.
Figure 2
Figure 2
Medicines associated with drug‐induced autoimmune hepatitis.
Figure 3
Figure 3
Panel a: Clinical presentation at diagnosis. DIAIH: formula image, No; formula image, Yes. Panel b: comparison of liver biochemical tests at diagnosis of classic hepatitis versus autoimmune hepatitis associated with drugs. formula image, ALT P = 0.37; formula image, AST P = 0.37; formula image, ALP P = 0.72.
Figure 4
Figure 4
Survival and response to management. Differential survival according to idiopathic or drug‐induced autoimmune hepatitis (panel a) and response to medical management over time (panel b). DIAIH: formula image, No; formula image, Yes.
See this image and copyright information in PMC

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