Natural history and outcomes in drug-induced autoimmune hepatitis

作者：Yeong Tian T; Lim Kok H J; Goubet Stephanie; Parnell Nick; Verma Sumita^*

来源：Hepatology Research, 2016, 46(3): E79-E88.

DOI：10.1111/hepr.12532

• drug-induced liver injury
• herbal remedies
• nitrofurantoin
• statins

AimDrug-induced autoimmune hepatitis (DIAIH) remains poorly characterized. Our aim was to assess natural history and outcomes in DIAIH.
MethodsThis was a retrospective cohort study.
ResultsEighty-two patients with autoimmune hepatitis (AIH) were identified, 11 (13.4%) with DIAIH, implicated drugs being nitrofurantoin (n=4), statins (n=4), herbal remedies (n=2) and diclofenac (n=1). Female sex, acute onset, elevated serum globulins/immunoglobulin G, fibrosis stage (Ishak), cirrhosis at onset, moderate-severe portal inflammation, interface and lobular hepatitis, remission, relapse and poor outcome were similar in those with DIAIH and AIH (P>0.05). The former were however more likely to be aged 60years or more and take longer to relapse on immunosuppression discontinuation (P=<0.05). On Kaplan-Meier analysis, probability of poor outcome was similar in those with DIAIH and AIH (log-rank test, 0.339). On comparing those with (n=4) and without nitrofurantoin (n=7) DIAIH, the former were older, had longer duration of drug use prior to DIAIH diagnosis, higher fibrosis stage and were less likely to relapse upon immunosuppression discontinuation.
ConclusionApproximately 15% of patients with AIH have DIAIH with similar outcomes, although the latter are older with a propensity for late relapse, mandating long-term follow up.

• 出版日期2016-3