Differential characteristics in drug‐induced autoimmune hepatitis. Issue 3 (24th May 2018)

• Record Type: Journal Article
• Authors: Martínez‐Casas, Omar Yesid; Díaz‐Ramírez, Gabriel Sebastián; Marín‐Zuluaga, Juan Ignacio; Muñoz‐Maya, Octavio; Santos, Oscar; Donado‐Gómez, Jorge Hernando; Restrepo‐Gutiérrez, Juan Carlos
• Is Part Of: JGH open. Volume 2:Issue 3(2018)
• Page Start: 97
• Page End: 104
• Publication Date: 2018-05-24
• Subjects: autoimmune hepatitis -- autoimmunity -- drug‐induced liver injury -- immunosuppression -- prognosis
• DOI: 10.1002/jgh3.12054
• Languages: English
• ISSNs: 2397-9070

Abstract

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. Abstract : In this largest cohort study of Latin America, drug‐induced autoimmune hepatitis (DIAIH) constitutes a minor proportion of the autoimmune hepatitis (AIH) total. The clinical and histological characteristics may be similar; however, DIAIH patients have a greater chance of suspending the treatment with low risk of relapse, progression to cirrhosis or need for transplantation.