Drug-induced autoimmune hepatitis: Clinical characteristics and prognosis

Bjõrnsson, Einar; Talwalkar, Jayant A.; Treeprasertsuk, Sombat; Kamath, Patrick S.; Takahashi, Naoki; Sanderson, Schuyler O.; Neuhauser, Matthias; Lindor, Keith

doi:10.1002/hep.23588

Cited by 424 publications

(548 citation statements)

References 28 publications

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“…In contrast to Björnsson's et al 7. findings, which report an equal number of cases of minocycline with nitrofurantoin in DIAIH,3 and the prospective DILIN study,16 in which minocycline is the second cause of DIAIH, our cohort does not register cases secondary to minocycline given its lower commercialization and difficulty to find it in Colombia despite INVIMA's (National Institute of Drug Vigilance) approval and registration in 2008.…”

Section: Discussioncontrasting

confidence: 88%

“…This was demonstrated in the Drug‐Induced Liver Injury Network (DILIN) prospective study 16. In this study, nitrofurantoin and NSAIDs accounted for 84% of the cases of DIAIH, with nitrofurantoin being 67% higher than that reported in the series described by Björnsson et al 7. and Licata et al 15…”

Section: Discussionmentioning

confidence: 54%

“…This is similar to the results reported in series 4, 9, 10. However, unlike these reports, the proportion of DIAIH in this study was somewhat minor; Björnsson et al ., in a 10‐year retrospective cohort study from the Mayo Clinic, found 9.2% (24 out of 261)7 and 8.8% (12 out of 136 patients) patients diagnosed with drug hepatotoxicity in an Italian study published by Licata et al 15. This study indicates a proportion of 6.3% of the global AIH patients, confirming variations among countries that are possibly due to population differences and heterogeneous availability in drugs associated with this entity.…”

Section: Discussionmentioning

confidence: 63%

“…Regarding the histological characteristics as initially demonstrated by Björnsson et al 7. and later by Suzuki et al 3,.…”

Section: Discussionmentioning

confidence: 93%

“…Retrospective unicentric series7, 8 show slight variation in the proportion of DIAIH and differences in early response against late response with the immunosuppression management. The reports regarding this in Latin America are very scarce and limited to reports of isolated cases, such as a case of anti‐tumor necrosis factor (TNF)9 reported in Medellín, Colombia, and a case of a teenage patient who started treatment with isotretionin for severe acne and was later diagnosed with DIAIH in Lima, Peru 10…”

Section: Introductionmentioning

confidence: 99%

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Differential characteristics in drug‐induced autoimmune hepatitis

et al. 2018

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Background and AimDrug‐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.MethodsThis 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.ResultsA 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.ConclusionDIAIH 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.

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 63%

“…Regarding the histological characteristics as initially demonstrated by Björnsson et al 7. and later by Suzuki et al 3,.…”

Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Differential characteristics in drug‐induced autoimmune hepatitis

et al. 2018

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Liraglutide-Induced Autoimmune Hepatitis

et al. 2014

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he incidence and prevalence of diabetes mellitus in the United States is increasing rapidly.1 Eleven unique drug classes have been approved by the US Food and Drug Administration for type 2 diabetes mellitus. 1 Incretin-based hypoglycemic agents, including the glucagon-like peptide 1 (GLP-1) agonists and the dipeptidyl peptidase-4 inhibitors, have recently received considerable press. The US Food and Drug Administration released a statement heightening provider awareness of potential adverse events after data linking these drugs to an increased risk for pancreatic cancer surfaced. 2 Despite these warnings, the American Association of Clinical Endocrinologists guidelines 3 recommend the use of incretin mimetic drugs early in the process of intensifying glycemic control.Incretin-based hypoglycemic agents have also been implicated in cases of hepatotoxic effects. 4,5 Identifying drug-induced liver injury (DILI) is challenging, because cases are rare and can have variable presentations, including hepatic steatosis, acute liver failure, hepatic necrosis, cholestatic hepatitis, and autoimmune hepatitis (AIH). 6 A drug's hepatotoxic potential is often recognized only after approval by the US Food and Drug Administration. 6 We present the first case, to our knowledge, of drug-induced marker-negative AIH associated with liraglutide (Victoza; Novo Nordisk), a GLP-1 agonist approved in 2010 for type 2 diabetes mellitus. Report of a CaseA young Hispanic woman with a medical history of type 2 diabetes mellitus and vitiligo presented with nausea, emesis, and acute hepatitis of 10 days' duration. Other than switching drug therapy from exenatide, 10 μg twice daily, to liraglutide, 1.2 mg/d, 4 months before presentation, the patient reported no changes in medication use or use of herbal supplements or acetaminophen. For the last 3 years she had taken metformin hydrochloride, 500 mg twice daily, and used topical tacrolimus ointment, 0.1%, for her vitiligo. Her social history was unremarkable other than recent travel to the southern United States. Physical examination findings included mild scleral icterus but no evidence of advanced liver disease, abdominal tenderness, or altered mentation.

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Drug‐Induced Liver Injury

Bjõrnsson

Chalasani

2016

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Drug-induced liver injury (DILI) is an adverse reaction to drugs or other xenobiotics that occurs either as a predictable event when the subject is exposed to toxic doses of some compounds (acetaminophen overdose) or in an unpredictable way with many drugs in common use. Drugs can be harmful to the liver in a susceptible subject on the background of genetic and environmental factors. This accounts for modifications in the hepatic metabolism and excretion of the agent leading to cellular stress, direct cell death, activation of an adaptive immune response and a failure to adapt with progression to overt liver injury. Idiosyncratic DILI is a relative rare liver disorder but can be severe and even fatal, presenting with a variety of phenotypes, which mimic almost every other liver disease. Diagnosis of DILI relies on the exclusion of other etiologies of liver disease as specific biomarkers are still lacking. Clinical scales such as CIOMS/RUCAM can support the diagnostic process but need a refinement. A number of clinical variables, validated in prospective cohorts, can be used to predict a more severe DILI outcome. Although no pharmacological therapy has yet been adequately tested in randomized clinical trials, corticosteroids can be useful, particularly in the emergent form of DILI related to immune checkpoint inhibitors.

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Drug-induced autoimmune hepatitis: Clinical characteristics and prognosis

Cited by 424 publications

References 28 publications

Differential characteristics in drug‐induced autoimmune hepatitis

Differential characteristics in drug‐induced autoimmune hepatitis

Liraglutide-Induced Autoimmune Hepatitis

Drug‐Induced Liver Injury

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