Unveiling Drug-Induced Autoimmune-Like Hepatitis in Autoimmune Hepatitis Patients: A Multicenter Retrospective Study.

Area of Science:

• Hepatology
• Clinical Pharmacology
• Autoimmune Diseases

Background:

• Drug-induced autoimmune-like hepatitis (DI-ALH) mimics autoimmune hepatitis (AIH) but is often underdiagnosed.
• Exposure to drugs and herbal and dietary supplements (HDS) can trigger DI-ALH.

Purpose of the Study:

• To determine the prevalence of drug/HDS exposure in AIH patients at diagnosis.
• To identify features distinguishing DI-ALH from AIH and predict disease evolution.

Main Methods:

• Retrospective analysis of 705 patients diagnosed with AIH.
• DI-ALH defined by published criteria.
• Clinical, biochemical, serological, and histological data analyzed.

Main Results:

• 59% of patients reported drug/HDS exposure; 8% met DI-ALH criteria.
• Statins and HDS were common causes.
• DI-ALH patients had more severe presentations (acute/fulminant hepatitis) and higher transaminase levels.
• DI-ALH showed faster biochemical response to immunosuppression but also flares upon treatment withdrawal attempts.

Conclusions:

• DI-ALH is under-recognized, leading to unnecessary long-term immunosuppression.
• Establishing a causal link between drugs and AIH is vital.
• Treatment withdrawal and long-term follow-up are essential to prevent overtreatment complications.