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Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report
Journal of Hepatology ( IF 25.7 ) Pub Date : 2023-05-08 , DOI: 10.1016/j.jhep.2023.04.033
Raúl J Andrade 1 , Guruprasad P Aithal 2 , Ynto S de Boer 3 , Rodrigo Liberal 4 , Alexander Gerbes 5 , Arie Regev 6 , Benedetta Terziroli Beretta-Piccoli 7 , Christoph Schramm 8 , David E Kleiner 9 , Eleonora De Martin 10 , Gerd A Kullak-Ublick 11 , Guido Stirnimann 12 , Harshad Devarbhavi 13 , John M Vierling 14 , Michael P Manns 15 , Marcial Sebode 16 , Maria Carlota Londoño 17 , Mark Avigan 18 , Mercedes Robles-Diaz 1 , Miren García-Cortes 1 , Edmond Atallah 2 , Michael Heneghan 19 , Naga Chalasani 20 , Palak J Trivedi 21 , Paul H Hayashi 22 , Richard Taubert 23 , Robert J Fontana 24 , Sabine Weber 5 , Ye Htun Oo 25 , Yoh Zen 26 , Anna Licata 27 , M Isabel Lucena 28 , Giorgina Mieli-Vergani 29 , Diego Vergani 29 , Einar S Björnsson 30 ,
Affiliation  

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.



中文翻译:

药物性自身免疫样肝炎(DI-ALH)的命名、诊断和治疗:专家意见会报告

药物性肝损伤 (DILI) 几乎可以模仿所有其他肝脏疾病。自身免疫性肝炎(ALH)越来越多地归因于药物。本文总结了药物性肝损伤联盟和国际自身免疫性肝炎小组举行的联合国际会议上讨论的主要主题。DI-ALH 是一种肝损伤,其实验室和/或组织学特征可能与自身免疫性肝炎 (AIH) 难以区分。既往研究表明,DI-ALH 患者与特发性AIH 患者具有非常相似的临床、生化、免疫学和组织学特征。区分 DI-ALH 和 AIH 很重要,因为 DI-ALH 患者很少需要长期免疫抑制,并且在停药后病情通常会自行缓解,而 AIH 患者大多需要长期免疫抑制。因此,在某些情况下,可能需要通过长期随访修改诊断。DI-ALH 涉及40 多种不同的药物,包括呋喃妥因、甲基多巴、肼屈嗪、米诺环素、英夫利昔单抗、草药和膳食补充剂(如阿拉伯茶和心叶青牛胆)。由于缺乏可以进行精确诊断的疾病特异性标志物,对 DI-ALH 的了解受到限制,而同样没有单一特征可以诊断 AIH。我们提出了一种针对肝损伤和自身免疫表型患者的管理算法。迫切需要系统性地前瞻性评估 DI-ALH 患者,以明确该病症的特征。

更新日期:2023-05-08
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