Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): an expert opinion meeting report.
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Author
Andrade, Raúl JAithal, Guruprasad P
de Boer, Ynto S
Liberal, Rodrigo
Gerbes, Alexander
Regev, Arie
Beretta-Piccoli, Benedetta Terziroli
Schramm, Christoph
Kleiner, David E
De Martin, Eleonora
Kullak-Ublick, Gerd A
Stirnimann, Guido
Devarbhavi, Harshad
Vierling, John M
Manns, Michael P
Sebode, Marcial
Londoño, Maria Carlota
Avigan, Mark
Robles-Diaz, Mercedes
García-Cortes, Miren
Atallah, Edmond
Heneghan, Michael
Chalasani, Naga
Trivedi, Palak J
Hayashi, Paul H
Taubert, Richard
Fontana, Robert J
Weber, Sabine
Oo, Ye Htun
Zen, Yoh
Licata, Anna
Lucena, M Isabel
Mieli-Vergani, Giorgina
Vergani, Diego
Björnsson, Einar S
Publication date
2023-05-08
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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 summarizes the major topics discussed at a joint International Conference held between 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 often resolve spontaneously after stopping the culprit drug whereas patients with AIH mostly need 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 a precise diagnosis and similarly, there is no single feature which is diagnostic of AIH. A management algorithm is proposed. There is an urgent need to prospectively evaluate patients with DI-ALH systematically to enable definitive characterization of this condition.Citation
Andrade RJ, Aithal GP, de Boer YS, Liberal R, Gerbes A, Regev A, Beretta-Piccoli BT, Schramm C, Kleiner DE, De Martin E, Kullak-Ublick GA, Stirnimann G, Devarbhavi H, Vierling JM, Manns MP, Sebode M, Londoño MC, Avigan M, Robles-Diaz M, García-Cortes M, Atallah E, Heneghan M, Chalasani N, Trivedi PJ, Hayashi PH, Taubert R, Fontana RJ, Weber S, Oo YH, Zen Y, Licata A, Lucena MI, Mieli-Vergani G, Vergani D, Björnsson ES; IAIHG and EASL DHILI Consortium. Nomenclature, Diagnosis and Management of Drug-induced Autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report. J Hepatol. 2023 May 8:S0168-8278(23)00320-3. doi: 10.1016/j.jhep.2023.04.033. Epub ahead of print.Type
ArticleAdditional Links
http://www.sciencedirect.com/science/journal/01688278PMID
37164270Journal
Journal of HepatologyPublisher
Elsevierae974a485f413a2113503eed53cd6c53
10.1016/j.jhep.2023.04.033