Natural history and outcomes in drug‐induced autoimmune hepatitis. Issue 3 (25th May 2015)

• Record Type: Journal Article
• Authors: Yeong, Tian T.; Lim, Kok H. J.; Goubet, Stephanie; Parnell, Nick; Verma, Sumita
• Is Part Of: Hepatology research. Volume 46:Issue 3(2016)
• Page Start: E79
• Page End: E88
• Publication Date: 2015-05-25
• Subjects: drug‐induced liver injury -- herbal remedies -- nitrofurantoin -- statins; Liver -- Diseases -- Periodicals; Liver Diseases -- Periodicals; Foie -- Maladies -- Périodiques; 616.362
• DOI: 10.1111/hepr.12532
• Languages: English
• ISSNs: 1386-6346

Abstract

Abstract : Aim: Drug‐induced autoimmune hepatitis (DIAIH) remains poorly characterized. Our aim was to assess natural history and outcomes in DIAIH. Methods: This was a retrospective cohort study. Results: Eighty‐two patients with autoimmune hepatitis (AIH) were identified, 11 (13.4%) with DIAIH, implicated drugs being nitrofurantoin ( n = 4), statins ( n = 4), herbal remedies ( n = 2) and diclofenac ( n = 1). Female sex, acute onset, elevated serum globulins/immunoglobulin G, fibrosis stage (Ishak), cirrhosis at onset, moderate–severe portal inflammation, interface and lobular hepatitis, remission, relapse and poor outcome were similar in those with DIAIH and AIH ( P > 0.05). The former were however more likely to be aged 60 years or more and take longer to relapse on immunosuppression discontinuation ( P = <0.05). On Kaplan–Meier analysis, probability of poor outcome was similar in those with DIAIH and AIH (log–rank test, 0.339). On comparing those with ( n = 4) and without nitrofurantoin ( n = 7) DIAIH, the former were older, had longer duration of drug use prior to DIAIH diagnosis, higher fibrosis stage and were less likely to relapse upon immunosuppression discontinuation. Conclusion: Approximately 15% of patients with AIH have DIAIH with similar outcomes, although the latter are older with a propensity for late relapse, mandating long‐term follow up.