Drug-induced autoimmune hepatitis: Clinical characteristics and prognosis

Einar Björnsson, Jayant Talwalkar, Sombat Treeprasertsuk, Patrick S. Kamath, Naoki Takahashi, Schuyler Sanderson, Matthias Neuhauser, Keith Lindor

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Abstract

Drug-induced autoimmune hepatitis (DIAIH) has been reported to be caused by several drugs. There is a lack of data comparing these patients with other patients with autoimmune hepatitis (AIH). A search was performed using the Mayo Clinic diagnostic medical index for AIH patients and DIAIH patients identified over 10 years. Individuals with overlap syndromes and decompensated liver disease were excluded. Overall, 261 patients (204 females, median age 52) were identified, and 24 (9.2%) were DIAIH cases with a median age of 53 (interquartile range, 24-61). Two drugs, nitrofurantoin (n = 11) and minocycline (n = 11), were the main causes. A similar proportion of DIAIH patients had positive antinuclear antibodies (83% versus 70%) and smooth muscle antibodies (50% versus 45%) as compared with AIH patients. Histological grade and stage were similar in patients with DIAIH versus AIH; however, none of the DIAIH patients had cirrhosis at baseline; this was present in 20% of matched AIH cases. Liver imaging was normal in all minocycline cases. Eight of 11 (73%) nitrofurantoin patients had abnormalities on hepatic imaging (mainly liver atrophy), a finding seen in only 8 of 33 (24%) of a random sample of the rest of the AIH group (P = 0.0089). Corticosteroid responsiveness was similar in DIAIH and the AIH patients. Discontinuation of immunosuppression was tried and successful in 14 DIAIH cases, with no relapses (0%), whereas 65% of the AIH patients had a relapse after discontinuation of immunosuppression (P < 0.0001). Conclusion: A significant proportion of patients with AIH have drug-induced AIH, mainly because of nitrofurantoin and minocycline. These two groups have similar clinical and histological patterns. However, DIAIH patients do not seem to require long-term immunosuppressive therapy.

Original languageEnglish (US)
Pages (from-to)2040-2048
Number of pages9
JournalHepatology
Volume51
Issue number6
DOIs
StatePublished - Jun 2010
Externally publishedYes

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Chemical and Drug Induced Liver Injury
Autoimmune Hepatitis
Nitrofurantoin
Minocycline
Immunosuppression
Liver
Recurrence

ASJC Scopus subject areas

  • Hepatology

Cite this

Björnsson, E., Talwalkar, J., Treeprasertsuk, S., Kamath, P. S., Takahashi, N., Sanderson, S., ... Lindor, K. (2010). Drug-induced autoimmune hepatitis: Clinical characteristics and prognosis. Hepatology, 51(6), 2040-2048. https://doi.org/10.1002/hep.23588

Drug-induced autoimmune hepatitis : Clinical characteristics and prognosis. / Björnsson, Einar; Talwalkar, Jayant; Treeprasertsuk, Sombat; Kamath, Patrick S.; Takahashi, Naoki; Sanderson, Schuyler; Neuhauser, Matthias; Lindor, Keith.

In: Hepatology, Vol. 51, No. 6, 06.2010, p. 2040-2048.

Research output: Contribution to journalArticle

Björnsson, E, Talwalkar, J, Treeprasertsuk, S, Kamath, PS, Takahashi, N, Sanderson, S, Neuhauser, M & Lindor, K 2010, 'Drug-induced autoimmune hepatitis: Clinical characteristics and prognosis', Hepatology, vol. 51, no. 6, pp. 2040-2048. https://doi.org/10.1002/hep.23588
Björnsson E, Talwalkar J, Treeprasertsuk S, Kamath PS, Takahashi N, Sanderson S et al. Drug-induced autoimmune hepatitis: Clinical characteristics and prognosis. Hepatology. 2010 Jun;51(6):2040-2048. https://doi.org/10.1002/hep.23588
Björnsson, Einar ; Talwalkar, Jayant ; Treeprasertsuk, Sombat ; Kamath, Patrick S. ; Takahashi, Naoki ; Sanderson, Schuyler ; Neuhauser, Matthias ; Lindor, Keith. / Drug-induced autoimmune hepatitis : Clinical characteristics and prognosis. In: Hepatology. 2010 ; Vol. 51, No. 6. pp. 2040-2048.
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abstract = "Drug-induced autoimmune hepatitis (DIAIH) has been reported to be caused by several drugs. There is a lack of data comparing these patients with other patients with autoimmune hepatitis (AIH). A search was performed using the Mayo Clinic diagnostic medical index for AIH patients and DIAIH patients identified over 10 years. Individuals with overlap syndromes and decompensated liver disease were excluded. Overall, 261 patients (204 females, median age 52) were identified, and 24 (9.2{\%}) were DIAIH cases with a median age of 53 (interquartile range, 24-61). Two drugs, nitrofurantoin (n = 11) and minocycline (n = 11), were the main causes. A similar proportion of DIAIH patients had positive antinuclear antibodies (83{\%} versus 70{\%}) and smooth muscle antibodies (50{\%} versus 45{\%}) as compared with AIH patients. Histological grade and stage were similar in patients with DIAIH versus AIH; however, none of the DIAIH patients had cirrhosis at baseline; this was present in 20{\%} of matched AIH cases. Liver imaging was normal in all minocycline cases. Eight of 11 (73{\%}) nitrofurantoin patients had abnormalities on hepatic imaging (mainly liver atrophy), a finding seen in only 8 of 33 (24{\%}) of a random sample of the rest of the AIH group (P = 0.0089). Corticosteroid responsiveness was similar in DIAIH and the AIH patients. Discontinuation of immunosuppression was tried and successful in 14 DIAIH cases, with no relapses (0{\%}), whereas 65{\%} of the AIH patients had a relapse after discontinuation of immunosuppression (P < 0.0001). Conclusion: A significant proportion of patients with AIH have drug-induced AIH, mainly because of nitrofurantoin and minocycline. These two groups have similar clinical and histological patterns. However, DIAIH patients do not seem to require long-term immunosuppressive therapy.",
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