Copyright ©2014 Baishideng Publishing Group Co.
World J Hepatol. Apr 27, 2014; 6(4): 160-168
Published online Apr 27, 2014. doi: 10.4254/wjh.v6.i4.160
Table 1 Classification of drug-induced autoimmune liver disease
AIH with DILIPatients with known AIH AIH quiescent: the drug may be the trigger of a new bout AIH under IS or corticosteroids treatment: Reactivation of known AIH upon intro duction of a newdrug (very difficult to demonstrate a causal relationship as it might be coincidental Often advanced fibrosis on histology
DI-AIHPatients with a low grade disease not diagnosed before or predisposition to AIH Drug produce an immune reaction that lead to a chronic process: Perpetuating the AIH Permanent need of IS Habitually typical HLA-DR associated
IM-DILI (Autoimmune hypersensitivity)Fever, eosinophilia, lymphadenopathy, rush Indistinguishable from true AIH: Mandatory IS treatment Frequently spontaneous remission after drug cessation Usually complete response to treatment and sustained remission without relapse It is the most frequent drug-induced immune process in the liver attributable to drugs
Mixed autoimmune typePatients with mixed clinical features of DI-AIH and IM-DILI Complete response to IS treatment but with chronic course after withdrawal Patients under IS treatment for another autoimmune disease. Withdraw IS drugs is not possible. Remission cannot be evaluated
DILI with positive autoantibodiesPatients with positive autoantibodies The probability of developing DIAILD increases in second DILI episodes indepe dently of the causal agent
Table 2 Elements to be reported when a case of drug- induced autoimmune liver disease is suspected
Previously obtained ANA
During the treatment with the suspicious drug
After drug withdrawal
Check for the presence of HLA-DR:
Drug type
Time to onset from the beginning of the treatment
AIH diagnosed:
During the course of treatment
After withdrawal of the drug
AIH scales for diagnosis
International autoimmune hepatitis group report (4)
Simplified score (5)
Previous DILI episodes
Response to corticosteroids
Autoimmune titres evolution
IgG values evolution
Table 3 Drugs and drug-induced autoimmune liver disease
Well stablished drugs:
Oxyphenisatin, alpha-methyl-dopa, clometacin.
Emerging drugs:
Biologics agents:
Others: adalimumab, etanercept, efalizumab, ipilimumab
Other drugs:
Less compelling association (infrequent reports): atomoxetine, diclofenac, fenofibrate, pemoline, phenprocoumon, dihydralazine, tielinic acid, benzarone