TY - JOUR
T1 - Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH)
T2 - An expert opinion meeting report
AU - Andrade, Raúl J.
AU - Aithal, Guruprasad P.
AU - de Boer, Ynto S.
AU - Liberal, Rodrigo
AU - Gerbes, Alexander
AU - Regev, Arie
AU - Terziroli Beretta-Piccoli, Benedetta
AU - Schramm, Christoph
AU - Kleiner, David E.
AU - de Martin, Eleonora
AU - the IAIHG and EASL DHILI Consortium
AU - Kullak-Ublick, Gerd A.
AU - Stirnimann, Guido
AU - Devarbhavi, Harshad
AU - Vierling, John M.
AU - Manns, Michael P.
AU - Sebode, Marcial
AU - Londoño, Maria Carlota
AU - Avigan, Mark
AU - Robles-Diaz, Mercedes
AU - García-Cortes, Miren
AU - Atallah, Edmond
AU - Heneghan, Michael
AU - Chalasani, Naga
AU - Trivedi, Palak J.
AU - Hayashi, Paul H.
AU - Taubert, Richard
AU - Fontana, Robert J.
AU - Weber, Sabine
AU - Oo, Ye Htun
AU - Zen, Yoh
AU - Licata, Anna
AU - Lucena, M. Isabel
AU - Mieli-Vergani, Giorgina
AU - Vergani, Diego
AU - Björnsson, Einar S.
N1 - Funding Information: Ye Htun Oo is funded by The Sir Jules Thorn Charitable Trust. Funding Information: The present study has been supported by grants from Instituto de Salud Carlos III (ISCIII) cofounded by Fondo Europeo de Desarrollo Regional-FEDER (contract numbers: PI21/01248; PI19/00883; Clinical research platform of the Carlos III Health Institute: PT20/00127). SCReN and CIBERehd are funded by ISCIII (PI21/01248; PI19/00883; PT20/00127). This publication is based upon work from COST Action “CA17112—Prospective European Drug-Induced Liver Injury Network” supported by COST ( European Cooperation in Science and Technology, Cost Action CA-17112 ); www.cost.eu . The following authors are members of CA17112: RJA, ESB, MIL, GPA, GK-U, MR-D, MG-C, EA, AL, SW, AG, HD, MCL, GS, EDM. Open Access funding provided thanks to the CRUE-CSIC agreement with Wiley. Funding for open access charge: Universidad de Málaga/CBUA. Publisher Copyright: © 2023 The Author(s)
PY - 2023/9
Y1 - 2023/9
N2 - Drug-induced liver injury (DILI) can mimic almost all other liver disorders. A phenotype increasingly ascribed to drugs is autoimmune-like hepatitis (ALH). This article summarises the major topics discussed at a joint International Conference held between the Drug-Induced Liver Injury consortium and the International Autoimmune Hepatitis Group. DI-ALH is a liver injury with laboratory and/or histological features that may be indistinguishable from those of autoimmune hepatitis (AIH). Previous studies have revealed that patients with DI-ALH and those with idiopathic AIH have very similar clinical, biochemical, immunological and histological features. Differentiating DI-ALH from AIH is important as patients with DI-ALH rarely require long-term immunosuppression and the condition often resolves spontaneously after withdrawal of the implicated drug, whereas patients with AIH mostly require long-term immunosuppression. Therefore, revision of the diagnosis on long-term follow-up may be necessary in some cases. More than 40 different drugs including nitrofurantoin, methyldopa, hydralazine, minocycline, infliximab, herbal and dietary supplements (such as Khat and Tinospora cordifolia) have been implicated in DI-ALH. Understanding of DI-ALH is limited by the lack of specific markers of the disease that could allow for a precise diagnosis, while there is similarly no single feature which is diagnostic of AIH. We propose a management algorithm for patients with liver injury and an autoimmune phenotype. There is an urgent need to prospectively evaluate patients with DI-ALH systematically to enable definitive characterisation of this condition.
AB - Drug-induced liver injury (DILI) can mimic almost all other liver disorders. A phenotype increasingly ascribed to drugs is autoimmune-like hepatitis (ALH). This article summarises the major topics discussed at a joint International Conference held between the Drug-Induced Liver Injury consortium and the International Autoimmune Hepatitis Group. DI-ALH is a liver injury with laboratory and/or histological features that may be indistinguishable from those of autoimmune hepatitis (AIH). Previous studies have revealed that patients with DI-ALH and those with idiopathic AIH have very similar clinical, biochemical, immunological and histological features. Differentiating DI-ALH from AIH is important as patients with DI-ALH rarely require long-term immunosuppression and the condition often resolves spontaneously after withdrawal of the implicated drug, whereas patients with AIH mostly require long-term immunosuppression. Therefore, revision of the diagnosis on long-term follow-up may be necessary in some cases. More than 40 different drugs including nitrofurantoin, methyldopa, hydralazine, minocycline, infliximab, herbal and dietary supplements (such as Khat and Tinospora cordifolia) have been implicated in DI-ALH. Understanding of DI-ALH is limited by the lack of specific markers of the disease that could allow for a precise diagnosis, while there is similarly no single feature which is diagnostic of AIH. We propose a management algorithm for patients with liver injury and an autoimmune phenotype. There is an urgent need to prospectively evaluate patients with DI-ALH systematically to enable definitive characterisation of this condition.
KW - AIH
KW - DI-ALH
KW - DILI
KW - Drug-induced autoimmune-like hepatitis
KW - Liver injury
KW - autoimmune hepatitis
KW - diagnosis
KW - drug-induced liver injury
KW - epidemiology
KW - hepatotoxicity
KW - management
KW - outcome
UR - http://www.scopus.com/inward/record.url?scp=85161383047&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jhep.2023.04.033
DO - https://doi.org/10.1016/j.jhep.2023.04.033
M3 - Review article
C2 - 37164270
SN - 0168-8278
VL - 79
SP - 853
EP - 866
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 3
ER -