Drug-Induced Autoimmune Hepatitis: Response to Corticosteroids and Lack of Relapse After Cessation of Steroids

Bjõrnsson, Einar; Bergmann, Ottar M.; Jonasson, Jón G.; Gröndal, Gerður; Guðbjörnsson, Björn; Ólafsson, Sigurđur

doi:10.1016/j.cgh.2017.05.027

Cited by 61 publications

(71 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, there seems to be a lack of cross‐reactivity between TNF‐α inhibitors, possibly due to the difference in molecular structure of these agents. For instance, a patient with infliximab‐induced hepatocellular injury that resolved after cessation of infliximab was then successfully transitioned to adalimumab without DILI, which has also been reported in other studies . Additionally, even though ANA can be used to diagnose AIH, positive ANA status before the initiation of therapy did not seem to place the patient at greater risk of developing DILI .…”

Section: Tumor Necrosis Factor Alpha Inhibitorssupporting

confidence: 61%

Biologic and Checkpoint Inhibitor‐Induced Liver Injury: A Systematic Literature Review

2020

View full text Add to dashboard Cite

Biologics are among the most commonly prescribed medications for several chronic inflammatory diseases. Tumor necrosis factor alpha inhibitors, more so than other agents, have been observed to cause drug-induced liver injury. Additionally, because the approval and popularity of checkpoint inhibitors have grown, similar patterns of liver injury have been documented, with a majority of cases describing immune-mediated hepatitis. Although the exact mechanism of injury is unknown, various host and medication characteristics play a role in the outcome of the molecular cascade invoked by biologics. Prognosis is usually favorable with cessation of the offending agent, but cases of acute liver failure requiring liver transplantation have also been observed. Therefore, algorithms have been created to assist clinicians in treating drug-induced autoimmune hepatitis, mostly with corticosteroids. Additionally, case reports have documented successfully rechallenging patients with a different biologic without recurrence of liver injury, but data are limited. Further investigation is warranted regarding the potential for cross-reactivity and mechanism of injury to develop guidelines to aid clinicians in further management of these patients. (Hepatology Communications 2020;4:172-184).

show abstract

Section: Tumor Necrosis Factor Alpha Inhibitorssupporting

confidence: 61%

Biologic and Checkpoint Inhibitor‐Induced Liver Injury: A Systematic Literature Review

2020

View full text Add to dashboard Cite

show abstract

“…in a series of eight cases (seven with infliximab and one with adalimumab) in a single center in Portugal19 and Björnsson et al . in a cohort in Iceland, where 11 of 15 cases were secondary to infliximab 20. In both series, there was an early response (earlier than 2 months) to the withdrawal of the drug, along with short‐term immunosuppression without documented relapses.…”

Section: Discussionmentioning

confidence: 89%

Differential characteristics in drug‐induced autoimmune hepatitis

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

“…Moreover, data of all SMA and liver kidney microsomal antibodies (LKMA) measurements for the study period were acquired from the National University Hospital of Iceland immunology department, the only immunology laboratory in the country performing analysis of SMA and LKMA. Some of the cases of DIAIH in this study have been included in previous studies from our group . Medical records were reviewed, and patients included in the final analysis if they received the clinical diagnosis of AIH, marked by either ICD‐10 codes for AIH and chronic active hepatitis (K75.4 and K73.2 respectively) or the clinical records clearly stating AIH as the primary diagnosis in cases where codification of records was incomplete.…”

Section: Methodsmentioning

confidence: 99%

Increased incidence of autoimmune hepatitis is associated with wider use of biological drugs

Valgeirsson

Hreinsson

Bjõrnsson

2019

Liver International

View full text Add to dashboard Cite

Background & aims Population‐based studies on the epidemiology of autoimmune hepatitis (AIH) are scarce. Drug‐induced AIH (DIAIH) is increasingly recognized in association with immunomodulatory therapy. We aimed to determine the incidence, prevalence and natural history of AIH in a population‐based setting. Methods We collected data of new diagnosis of AIH in Iceland from 2006 to 2015. Cases were identified through search of diagnostic codes and text search for AIH within electronical medical records of all hospitals in Iceland and through records of smooth muscle antibodies (SMA) test results by the only laboratory in the country analyzing SMA. Patients were included in the final analysis if they received the clinical diagnosis of AIH or were started on immunosuppressive therapy. Results The mean annual incidence of AIH in Iceland was 2.2 cases per 100 000 inhabitants. Point prevalence on 31 December 2015 was 27/100 000. The median age at diagnosis was 56 years and 86% of patients were of female gender. DIAIH was suspected in 13 of 71 patients (18%) of which eight cases were related to infliximab. Immunosuppressive treatment was started in all but two patients. At the end of follow‐up (median 4.8 years) 66 of 71 (93%) patients were alive. Conclusion The incidence and prevalence rates of AIH in Iceland are the highest reported so far in a population‐based setting. Higher incidence can partly be explained by the increasing use of biological drugs. Immunosuppressive therapy was very effective in achieving remission and prognosis was favorable.

show abstract

Drug-Induced Autoimmune Hepatitis: Response to Corticosteroids and Lack of Relapse After Cessation of Steroids

Cited by 61 publications

References 7 publications

Biologic and Checkpoint Inhibitor‐Induced Liver Injury: A Systematic Literature Review

Biologic and Checkpoint Inhibitor‐Induced Liver Injury: A Systematic Literature Review

Differential characteristics in drug‐induced autoimmune hepatitis

Increased incidence of autoimmune hepatitis is associated with wider use of biological drugs

Contact Info

Product

Resources

About