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Clinical presentation, causative drugs and outcome of patients with autoimmune features in two prospective <scp>DILI</scp> registries
Author(s)
Aida Ortega‐Alonso
Gonzalo Matilla‐Cabello
Inmaculada Medina‐Cáliz
Agustín Castiella
Isabel Conde
Elvira Bonilla‐Toyos
José M. Pinazo-Bandera
Nelia Hernández
Martín Tagle
Vinícius Nunes
Raymundo Paraná
Fernando Bessone
Neil Kaplowitz
M. Isabel Lucena
Ismael Álvarez‐Álvarez
Mercedes Robles‐Díaz
Raúl J. Andrade
Date Issued
3 de junio de 2023
Type
Article
Volume
43
Issue
8
Start Page
1749
End Page
1760
Abstract
BACKGROUND & AIMS: Idiosyncratic drug-induced liver injury (DILI) with autoimmune features is a liver condition with laboratory and histological characteristics similar to those of idiopathic autoimmune hepatitis (AIH), which despite being increasingly reported, remains largely undefined. We aimed to describe in-depth the features of this entity in a large series of patients from two prospective DILI registries. METHODS: DILI cases with autoimmune features collected in the Spanish DILI Registry and the Latin American DILI Network were compared with DILI patients without autoimmune features and with an independent cohort of patients with AIH. RESULTS: Out of 1,426 patients with DILI, 33 cases with autoimmune features were identified. Female sex was more frequent in AIH patients than in the other groups (p = .001). DILI cases with autoimmune features had significantly longer time to onset (p < .001) and resolution time (p = .004) than those without autoimmune features. Interestingly, DILI patients with autoimmune features who relapsed exhibited significantly higher total bilirubin and transaminases at onset and absence of peripheral eosinophilia than those who did not relapse. The likelihood of relapse increased over time, from 17% at 6 months to 50% 4 years after biochemical normalization. Statins, nitrofurantoin and minocycline were the drugs most frequently associated with this phenotype. CONCLUSIONS: DILI with autoimmune features shows different clinical features than DILI patients lacking characteristics of autoimmunity. Higher transaminases and total bilirubin values with no eosinophilia at presentation increase the likelihood of relapse in DILI with autoimmune features. As the tendency to relapse increases over time, these patients will require long-term follow-up.
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