Autoimmune hepatitis and anti-tumor necrosis factor alpha therapy: A single center report of 8 cases

Table 1 Clinical characteristics of the patients in the series

Age/Gender	Disease/Disease duration	Anti-TNF drug	Dose mg/kg/number infusions/injections	Concomitant drugs	Symptoms	Transaminase levels (ALT/AST - x ULN)	Autoantibodies/ Immunoglobulins	Histology	AIH scorePost-therapy	Steroid response	Maintenance therapy	Outcome
1 - 36F	Distal UC/7 yr	IFX	5 mg/kg/5	Mesalamine	Yes	14/9	Anti-dsDNA, ANA, High IgG	Interface hepatitis	20	Yes	Mesalamine 3 g/d PO	Reversibility
2 - 45F	RA/10 yr	ADA	40 mg EOW/11	MTX NSAIDs	No	4.5/3	ANA, High IgG	Severe interface hepatitis	19	Yes	AZA 50 mg, ETC, Prednisolone 7.5 mg	Reversibility
3 - 34F	Distal UC/2 yr	IFX	5 mg/kg/8	Mesalamine	Yes	4.5/3	ANA, High IgG	Interface hepatitis	20	Yes	Mesalamine 3 g/d PO	Reversibility
4 - 35M	Extensive UC/2 yr	IFX	5 mg/kg/8	Mesalamine	No	13/7	ANA, High IgG	Interface hepatitis/marginal proliferation of bile ducts	20	Yes	Mesalamine 3 g/d PO	Controlled on therapy
											AZA 2.5 mg/kg per day
5 - 43M	AS/30 yr	IFX	5 mg/kg/5	-	No	25/15	High IgG	Interface hepatitis/cirrhosis	20	Yes	AZA 50 mg, Prednisolone 10 mg	Controlled on therapy
6 - 66F	Ileal CD/11 yr	IFX	5 mg/kg/13	Mesalamine, AZA	No	2/5	ANA	Chronic lymphoplasmocytic infiltrate	19	Yes	IFX 5 mg/kg AZA 2.5 mg/kg per day	Reversibility
7 - 37M	Ileal CD/2 yr	IFX	5 mg/kg/12	Mesalamine (suspended INH 2 mo prior to IFX)	No	4/2	ANA, High IgG	Interface hepatitis	20	Yes	Mesalamine 3 g/d PO	Reversibility
8 - 69F	Ileal CD/32 yr	IFX	5 mg/kg/4	Mesalamine	No	10/5	ANA	Interface hepatitis	19	Yes	Mesalamine 3 g/d PO	Reversibility

AS: Ankylosing spondylitis; PsA: Psoriatic arthritis; ULN: Upper limit of normal; UC: Ulcerative colitis; RA: Rheumatoid arthritis; CD: Crohn’s disease; PPP: Palmoplantar pustular psoriasis; PsO: Psoriasis; IFX: Infliximab; ADA: Adalimumab; ETC: Etanercept; AZA: Azathioprine; MTX: Methotrexate; INH: Isoniazid; EOW: Every other week; dsDNA: Double strand DNA; ASMA: Anti-smooth muscle antibodies; AMA: Anti-mitochondrial antibodies.

Table 2 Clinical characteristics of patients in published cases

Case - Year	Age/Gender	Disease	Anti-TNF drug	Immunosuppressant	Dose mg/kg/n-infusions	Symptoms	Autoantibodies	Histology	Steroid response	Outcome
20073	56/F	AS	IFX	None	5/6	Yes	Anti-dsDNA, ANA, ASMA	Piecemeal necrosis	Yes	Reversibility
20054	53/F	PsA	IFX	MTX	3/8	No	Anti-dsDNA, ANA, ASMA	Severe interface hepatitis	Yes	Reversibility
200712	54/F	RA	IFX	MTX	3/12	No	ANA	Chronic inflammation	Yes	Reversibility
20107	60/M	CD	IFX	None	5/4	No	Anti-dsDNA, ANA, ASMA	Interface hepatitis	Yes	Reversibility
20098	22/F	PPP	IFX	None	5/3	No	None	Interface hepatitis	Yes	Reversibility
201010	40/F	PsO, PsA	IFX	NSAIDS	5/5	Yes	Anti-dsDNA, ANA	Chronic hepatitis with portal+periportal fibrosis	Yes	Reversibility
20109	37/M	PsO	IFX	None	5/3	Yes	Anti-dsDNA, ANA, ASMA Anti-dsDNA, ANA, AMA, anti-cardiolipin	Interface hepatitis	Yes	Reversibility
20109	51/M	PsO	IFX	None	5/3	Yes		Interface hepatitis + PBC Overlap syndrome	Yes	Reversibility
200111	36/F	RA	IFX	PDN 10 mg	3/3	Yes	Anti-dsDNA, ANA	Interface hepatitis	Yes	Reversibility
20106	36/F	PsA, PsO, CD	ADA	None	40 mg EOW 6th injection	Yes	Anti-dsDNA, ANA	Interface hepatitis	Yes	Reversibility
201212	46/F	CD	IFX	None	5/3	No	ANA, ASMA	Interface hepatitis	Yes	Reversibility
20085	30/F	UC	IFX	AZA	10/> 15	No	ANA,Anti-dsDNA	Interface hepatitis	Yes	Reversibility

AS: Ankylosing spondylitis; PsA: Psoriatic arthritis; RA: Rheumatoid arthritis; CD: Crohn’s disease; PPP: Palmoplantar pustular psoriasis; PsO: Psoriasis; IFX: Infliximab; ADA: Adalimumab; MTX: Methotrexate; AZA: Azathioprine; EOW: Every other week; dsDNA: Double stranded DNA; ASMA: Anti-smooth muscle antibodies; AMA: Anti-mitochondrial antibodies; PDN: Prednisolone; NSAIDs: Non-steroidal anti-inflammatory drugs; PBC: Primary biliary cirrhosis.