1. Nomenclature, Diagnosis and Management of Drug-induced Autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report
- Author
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Raúl J. Andrade, Guruprasad P. Aithal, Ynto S. de Boer, Rodrigo Liberal, Alexander Gerbes, Arie Regev, Benedetta Terziroli Beretta-Piccoli, Christoph Schramm, David E. Kleiner, Eleonora De Martin, Gerd A. Kullak-Ublick, Guido Stirnimann, Harshad Devarbhavi, John M. Vierling, Michael P. Manns, Marcial Sebode, Maria Carlota Londoño, Mark Avigan, Mercedes Robles-Diaz, Miren García-Cortes, Edmond Atallah, Michael Heneghan, Naga Chalasani, Palak J. Trivedi, Paul H. Hayashi, Richard Taubert, Robert J. Fontana, Sabine Weber, Ye Htun Oo, Yoh Zen, Anna Licata, M Isabel Lucena, Giorgina Mieli-Vergani, Diego Vergani, Einar S. Björnsson, Fernando Bessone, Raymundo Paraná, Gideon M. Hirschfield, Jack Uetrecht, Alessio Gerussi, Ana Lleo, Annarosa Floreani, Federica Invernizzi, Federica Pedica, Marco Carbone, Massimo Colombo, Jose Pinazo, Aida Ortega-Alonso, Judith Sanabria-Cabrera, Camilla Stephens, Ismael Alvarez-Alvarez, Hao Niu, Marina Villanueva, Daniel di Zeo, Antonio Segovia, Gonzalo Matilla, Alejandro Cueto, Enrique del Campo, Agustin Castiella, Mar Riveiro-Barciela, Maria Buti, Dermot Gleeson, Jessica Dyson, Rosa Miquel, Amber Bozward, Nelia Hernandez, Averell H. Sherker, Jay H. Hoofnagle, Katrina Loh, Ayako Suzuki, Mariana Cardoso, Yimin Mao, and Elena Gómez Dominguez
- Subjects
Hepatology ,610 Medicine & health - 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 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.
- Published
- 2023