Discontinuation of immunosuppression in patients with immune-mediated drug-induced liver injury or idiopathic autoimmune hepatitis: a case-control study

Article Article scientifique Article Discontinuation of immunosuppression in patients with immune-mediated drug-induced liver injury or idiopathic autoimmune hepatitis: a case-control study eng 2023-01-11 2023-02 author Hassoun Jérémy Department of Gastroenterology and Hepatology University Hospitals of Geneva and Faculty of Medicine Geneva Switzerland. 802422 author Goossens Nicolas Department of Gastroenterology and Hepatology University Hospitals of Geneva and Faculty of Medicine Geneva Switzerland. 509893 Département de médecine (DEMED) author Restellini Sophie Department of Gastroenterology and Hepatology University Hospitals of Geneva and Faculty of Medicine Geneva Switzerland. 583727 Département de médecine (DEMED) author Ramer Lucas Department of Gastroenterology and Hepatology University Hospitals of Geneva and Faculty of Medicine Geneva Switzerland. 781985 author Ongaro Marie Department of Gastroenterology and Hepatology University Hospitals of Geneva and Faculty of Medicine Geneva Switzerland. 676058 author Giostra Emiliano Department of Gastroenterology and Hepatology University Hospitals of Geneva and Faculty of Medicine Geneva Switzerland. 609263 author Hadengue Antoine Department of Gastroenterology and Hepatology University Hospitals of Geneva and Faculty of Medicine Geneva Switzerland. 30244 Décanat et administration de la faculté de médecine (ADMED) author Rubbia-Brandt Laura Department of Clinical Pathology University Hospitals of Geneva and Faculty of Medicine Geneva Switzerland. 31809 Département de pathologie et immunologie (PATIM) author Spahr Laurent François Joséph 0000-0001-8407-2463 Department of Gastroenterology and Hepatology University Hospitals of Geneva and Faculty of Medicine Geneva Switzerland. 33759 Département de médecine (DEMED) 135-140 10.1002/jgh3.12862 36852147 2397-9070 PMC9958343 Background and aim: Drug-induced liver injury (DILI) may present with autoimmune features and require immunosuppressive therapy (IST) to reach biochemical response. Discontinuation of IST without hepatitis relapse may be more frequent in these patients as compared to patients with classical autoimmune hepatitis (AIH). We aimed to determine baseline characteristics and outcome of patients with immune-mediated drug induced liver injury (IMDILI) with particular emphasis on IST during follow-up. Methods: We performed a single-center retrospective study of consecutive patients presenting at a tertiary care center between January 2005 and December 2019 either with IMDILI or with classical AIH, for whom full baseline characteristics and a close follow-up were available over a 12-month period. Results: Overall, 31 patients (IMDILIn = 16, mean age 59 [34-74] years; AIHn = 15, mean age 47 [15-61] years) were included, showing similar biochemical, serological, and histological characteristics. Incriminating drugs in IMDILI patients were mostly represented by nonsteroidal antiinflammatory drugs and sartans. Initial corticosteroids combined with IST led to biochemical response in all patients. Compared to idiopathic AIH, more patients with IMDILI were weaned off corticosteroids at the end of follow-up (11/16 [68.7%]vs4/15 [26.6%],P < 0.02). At 1 year of follow-up, more patients in the IMDILI group compared to the classical AIH group were off any type of IST (13/16 [81%]vs15/15 [100%],P = 0.08). Conclusions: Although presenting with similar baseline biochemical and histological characteristics as idiopathic AIH, patients with IMDILI may not require long-term IST. Autoantibody Gamma globulins Histological damage Immune‐mediated drug‐induced liver injury Liver biopsy Transaminases Dewey 616.07 Dewey 616 137 Département de pathologie et immunologie 21F 56 Département de médecine 221 false 391 Métastases du foie 657 JGH open 7 2 8fa94020-7bba-4748-b1e2-688f01274da0 Article (Published version) Public Article-scientifique-from-europePmc.pdf 505459 application/pdf CC BY-NC-ND 1654d4b2928b876eb0da64333451e973b83f96bdcc62be0591e8433b2f4f7eb5 openAccess Faculté de médecine / Section de médecine fondamentale / Département de pathologie et immunologie Faculté de médecine / Section de médecine clinique / Département de médecine

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Discontinuation of immunosuppression in patients with immune-mediated drug-induced liver injury or idiopathic autoimmune hepatitis: a case-control study	JGH open	2023	112	170
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Hassoun, Jérémy