Tan CK, Ho D, Wang LM, Kumar R. Drug-induced autoimmune hepatitis: A minireview. World J Gastroenterol 2022; 28(24): 2654-2666 [PMID: 35979160 DOI: 10.3748/wjg.v28.i24.2654]
Corresponding Author of This Article
Rahul Kumar, FRCP, Assistant Professor, Gastroenterology and Hepatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore. rahul.kumar@singhealth.com.sg
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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a: National prospective DILI database (n = 1322), subgroup of DILI secondary to Nitrofurantoin, hydralazine, Minocycline and methyldopa (n = 88); b: 2004-2014; c: 6 mo, 12 mo or 24 mo until normalization of LFT
a: Autoimmune (AI) DILI–AI score based on seropositivity for AIH antibodies and raised IgG); b: RUCAM (definite, highly probable and probable)
47, 3.6%
Two groups: (a) 18 non-AI DILI due to 4 drugs; (b) 67 (reference cohort, DILI due to Augmentin, Isoniazid, Diclofenac)
Similar HLA-DRB1*03:01 (15%) and HLADRB1*04:01 (9%) percentage in patients with DILI compared to population controls from National Marrow Donor Program (12% and 9%, respectively)
a: All DILI who underwent liver biopsy, n = 62; b: 1988-2010; c: Median 2290 d
a: Revised IAIHG criteria; b: RUCAM and JDD-W scale
23, NA
39
Culprit drugs: CAM (69.6%); NSAIDs (8.7%). IgG reduction in 87%. 50% (8/16) relapsed (4 not treated with steroids, 2 previously received steroids and 2 on tapering dose of steroid dosage). Median time to relapse 283 d (range, 47-1090 d). Rise in IgG with relapse
a: Single centre hospitalized patients with DILI, n =136 (44 with liver biopsy); b: 2000-2011; c: Mean 26 mo (12-84 mo), at least 1 yr after stopping immunosuppressants
Culprit drugs: NSAIDs (50%) - (Nimesulide/ketoprofen); Antimicrobials (25%) (Augmentin/Ceftriaxone); CAM (17%). 38.2% of all DILI patients had positive AIH antibodies but only 42.9% with positive antibodies have DIAIH. All DIAIH were treated with corticosteroids and all achieved remission at 15 mo. 58.3% (7/12) had addition of Azathioprine. One patient had a flare while on tapering prednisolone. In 41% (5/12), immunosuppressant was stopped after 2 yr, with no relapse
Table 2 Studies comparing drug-induced autoimmune hepatitis and autoimmune hepatitis
Ref.
a: Study population; b: Study period; c: Follow-up period
a: Definition of DIAIH/AIH; b: Causality tool assessment
a: Population based AIH study, n = 71; b: 2006-2018; c: Median 4.8 yr
a: Simplified AIH score, if not fulfilled, Revised IAIHG score is used; or received corticosteroids; b: RUCAM score (highly probable, probable and possible)
13, 18% (9/13 had liver biopsy)
58
Culprit drugs: Biologics (77%) - 80% were due to infliximab; Nitrofurantoin (15%)
a: Single centre cohort of 288 acute liver injury patients who received corticosteroid for DILI/AIH, n = 44; b: 2013-2018; c: Median 19 mo in DILI; 23 mo in AIH
a: Simplified AIH score and revised IAIHG criteria; b: RUCAM
22
22
Culprit drugs: NSAIDs (27.3%); Statins (9%); Direct oral anticoagulants (9%)