Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report

Andrade, Raúl J.; Aithal, Guruprasad P.; de Boer, Ynto S.; Liberal, Rodrigo; Gerbes, Alexander; Regev, Arie; Terziroli Beretta-Piccoli, Benedetta; 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.

Abstract

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.

Citation

Andrade, R. J., Aithal, G. P., de Boer, Y. S., Liberal, R., Gerbes, A., Regev, A., Terziroli Beretta-Piccoli, B., Schramm, C., Kleiner, D. E., De Martin, E., Kullak-Ublick, G. A., Stirnimann, G., Devarbhavi, H., Vierling, J. M., Manns, M. P., Sebode, M., Londoño, M. C., Avigan, M., Robles-Diaz, M., García-Cortes, M., …Björnsson, E. S. (2023). Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report. Journal of Hepatology, https://doi.org/10.1016/j.jhep.2023.04.033

• Journal Article Type: Article
• Acceptance Date: Apr 29, 2023
• Online Publication Date: May 8, 2023
• Publication Date: 2023-09
• Deposit Date: Jun 30, 2023
• Publicly Available Date: Jul 10, 2023
• Journal: Journal of Hepatology
• Print ISSN: 0168-8278
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1016/j.jhep.2023.04.033
• Keywords: Liver injury; hepatotoxicity; drug-induced liver injury; DILI; autoimmune hepatitis; AIH; DI-ALH; Drug-induced autoimmune-like hepatitis; epidemiology; diagnosis; management; outcome
• Public URL: https://nottingham-repository.worktribe.com/output/20567095
• Publisher URL: https://www.journal-of-hepatology.eu/article/S0168-8278(23)00320-3/fulltext
• Additional Information: Authors on behalf of the IAIHG and EASL DHILI Consortium.; ; This article is maintained by: Elsevier; Article Title: Nomenclature, Diagnosis and Management of Drug-induced Autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report; Journal Title: Journal of Hepatology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jhep.2023.04.033; Content Type: article; Copyright: © 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.