Natural history and outcomes in drug-induced autoimmune hepatitis

Tian T Yeong; Kok H J Lim; Stephanie Goubet; Nick Parnell; Sumita Verma

doi:10.1111/hepr.12532

Natural history and outcomes in drug-induced autoimmune hepatitis

Hepatol Res. 2016 Mar;46(3):E79-88. doi: 10.1111/hepr.12532. Epub 2015 May 25.

Authors

Tian T Yeong¹, Kok H J Lim², Stephanie Goubet³, Nick Parnell², Sumita Verma^{1

2}

Affiliations

¹ Departments of Medicine, Brighton and Sussex Medical School, Brighton, UK.
² Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK.
³ Clinical and Investigation Research Unit, Brighton and Sussex University Hospital, Brighton, UK.

PMID: 25943838
DOI: 10.1111/hepr.12532

Abstract

Aim: Drug-induced autoimmune hepatitis (DIAIH) remains poorly characterized. Our aim was to assess natural history and outcomes in DIAIH.

Methods: This was a retrospective cohort study.

Results: Eighty-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 60 years 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.

Conclusion: Approximately 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.

Keywords: drug-induced liver injury; herbal remedies; nitrofurantoin; statins.