Drug-induced autoimmune hepatitis: A minireview

Table 4 Comparison between drug-induced autoimmune hepatitis and autoimmune hepatitis

Clinical features	DIAIH	AIH
Demographics
Female, %	82%[32]; 91%[34]	80% (P = 0.635)[32]; 92% (P = 0.95)[34]
Clinical presentation
Acute presentation	> 60%[14]; 55%[32]; 83%[34]	< 20%[14]; 47% (P = 0.618)[32]; 35% (P < 0.001)[34]
Hypersensitivity reaction (fever, rash, eosinophilia)	Up to 30%[14]	Unusual[14]
Cirrhosis at presentation, %	0%[34]	34.8% (P = 0.07)[34]
Temporal relationship with drugs	Positive	Negative
Concurrent AI disease	Unusual[14]	Present in 14%-44%[14]
Biochemical results
ALT (U/L), mean ± SD	548 ± 335[20]	227 ± 121 (P = 0.021)[20]
AST (U/L), mean ± SD	460 ± 321[20]	202 ± 57 (P = 0.018)[20]
Serology
IgG, mean ± SD (g/L)	13.4 g/L[14]; 21.4 ± 7.5[34]	18.6 g/L (P value non-significant)[14]; 24.3 ± 11.2 (P = 0.422)[34]
Pre-treatment score
RUCAM score, median (range)	6 (3-10)[21]	3.5 (0-7) (P < 0.01)[21]
Revised IAIHG score, median (range)	9.5 (4-14)[21]	13 (9-18)[21]
Simplified AIH score, median (range)	4 (2-6)[21]	5 (1-7) (P = 0.385)[21]
Histopathology
F3-F4, %	33.3%[34]	54.4% (P = 0.15)[34]
Typical histology (portal inflammation, interface hepatitis, plasma cells infiltrates)	18.2%[20]	54%[20]
Treatment and response to treatment
Time to biochemical remission, mean (mo)	2[34]	16.8 (P <0.001)[34]
Treatment with Azathioprine or Mycophenolic acid in addition to corticosteroids, %	57%[13]; 15%[14]; 28%[20]; 20%[21]	86% (P = 0.024)[13]; 83% (P < 0.001)[14]; 90% (P = 0.023)[20]; 85% (P < 0.01)[21]
Biochemical remission, %	95%[21]	77.3% (P = 0.08)[21]
Treatment discontinuation, %	69%[14]; 100%[20]; 85%[21]; 25%[34]	26% (P < 0.02)[14]; 25% (P = 0.013)[20]; 5% (P < 0.1)[21]; 3% (P < 0.001)[34]
Relapse rate, %	0%[14]; 15%[21]; 60%[32]; 0%[34]	43% (P = 0.022)[14]; 70% (P < 0.01)[21]; 83% (P = 0.538)[32]; 18% (P = 0.10)[34]
Time to relapse (wk), median (range)	131 (37-216)[34]	14 (1-155) (P = 0.033)[34]
Outcomes
Liver transplant/death, %	0%/0%[32,34]	2.8%/7% (P = 0.748 for liver transplant; p = 0.65 for death)[32]; 5.6%/2.8% (P = 0.40 for liver transplant; P = 0.55 for death)[34]

DIAIH: Drug-induced autoimmune hepatitis; DILI: Drug-induced liver injury; ALT: Alanine transaminase; AST: Aspartate transaminase; RUCAM: The Roussel Uclaf Causality Assessment Model; SD: Standard deviation.