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Unveiling Drug-Induced Autoimmune-Like Hepatitis in Autoimmune Hepatitis Patients: A Multicenter Retrospective Study

Fecha de publicación: Fecha Ahead of Print:

Autores de FUNDANET

Autores ajenos a FUNDANET

  • Arvaniti, P
  • Pascual-Dapena, A
  • Riveiro-Barciela, M
  • Esteban, P
  • Aguilar, A
  • Pérez-Medrano, I
  • Horta, D
  • Marcos, AC
  • Salcedo, M
  • Conde, I
  • Gómez, E
  • Castelló, I
  • Bárbara, JS
  • Díaz-González, A
  • del Barrio, M
  • Lorente, S
  • Mateos, B
  • Arencibia, A
  • Jiménez, M
  • Cuenca, P
  • Bernal-Monterde, V
  • Fernández, E
  • Rodríguez-Tajes, S
  • Pocurull, A
  • Hernández-Évole, H
  • Forns, X
  • Andrade, RJ
  • Londoño, M

Unidades de investigación

Abstract

Background and Aims Acute or chronic exposure to drugs or herbal and dietary supplements (HDS) can cause drug-induced autoimmune-like hepatitis (DI-ALH), a self-limiting condition resembling autoimmune hepatitis (AIH). We investigated the prevalence of drug exposure among AIH patients at diagnosis to recognise cases of DI-ALH and discern features predicting AIH development.Methods We retrospectively included 705 patients diagnosed with AIH. DI-ALH was defined using published criteria. The clinical, biochemical, serological, and histological data of DI-ALH and AIH were analysed to identify predictors of the evolution of each phenotype.Results Most patients were female (n = 496, 70%), with a median age of 57 years and a median follow-up of 55 months. A 59% (n = 417) reported exposure to drugs or HDS, and 8% (n = 58) fulfilled the criteria for DI-ALH. Statins and HDS were the most common culprits. Patients with DI-ALH more frequently had acute severe or fulminant hepatitis (22% vs. 12%, p = 0.013) and higher transaminase levels (ALT: 966 vs. 591, p = 0.001) at diagnosis. In total, 97% of the patients received immunosuppression. DI-ALH patients had a faster biochemical response than i-AIH patients (4 vs. 5, p = 0.031), while treatment withdrawal was attempted in only 29% (n = 17). Approximately 30% (n = 17) of DI-ALH cases presented a flare during follow-up. Neither clinical, histological, nor serological findings nor RUCAM and RECAM could predict a DI-ALH flare.Conclusions DI-ALH is often under-recognised in clinical practice, leading to unnecessary long-term immunosuppression. A causal relationship between drugs and AIH, along with an attempt to withdraw treatment and long-term follow-up, is essential to prevent overtreatment-associated risks.

Datos de la publicación

ISSN/ISSNe:
0269-2813, 1365-2036

ALIMENTARY PHARMACOLOGY & THERAPEUTICS  BLACKWELL PUBLISHING

Tipo:
Article
Páginas:
-
PubMed:
40857202
Factor de Impacto:
2,794 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 2

Citas Recibidas en Scopus: 3

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Keywords

  • autoimmune hepatitis; drug-induced autoimmune-like hepatitis; drug-induced liver injury; drugs/supplements; immunosuppression

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