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Article DI-ALH_APT.revMCL-1.pdf (651.56 KB)

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Document embargat fins el 2026-08-26

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2025-08-26

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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/227617

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

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https://doi.org/10.1111/apt.70353

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Background and Aims Acute or chronic exposure to drugs or herbal and dietary supplements (HDS) can cause drug-induced autoimmune-like hepatitis (DI-ALH), a self-limiting condition resembling autoimmune hepatitis (AIH). We investigated the prevalence of drug exposure among AIH patients at diagnosis to recognise cases of DI-ALH and discern features predicting AIH development.Methods We retrospectively included 705 patients diagnosed with AIH. DI-ALH was defined using published criteria. The clinical, biochemical, serological, and histological data of DI-ALH and AIH were analysed to identify predictors of the evolution of each phenotype.Results Most patients were female (n = 496, 70%), with a median age of 57 years and a median follow-up of 55 months. A 59% (n = 417) reported exposure to drugs or HDS, and 8% (n = 58) fulfilled the criteria for DI-ALH. Statins and HDS were the most common culprits. Patients with DI-ALH more frequently had acute severe or fulminant hepatitis (22% vs. 12%, p = 0.013) and higher transaminase levels (ALT: 966 vs. 591, p = 0.001) at diagnosis. In total, 97% of the patients received immunosuppression. DI-ALH patients had a faster biochemical response than i-AIH patients (4 vs. 5, p = 0.031), while treatment withdrawal was attempted in only 29% (n = 17). Approximately 30% (n = 17) of DI-ALH cases presented a flare during follow-up. Neither clinical, histological, nor serological findings nor RUCAM and RECAM could predict a DI-ALH flare.Conclusions DI-ALH is often under-recognised in clinical practice, leading to unnecessary long-term immunosuppression. A causal relationship between drugs and AIH, along with an attempt to withdraw treatment and long-term follow-up, is essential to prevent overtreatment-associated risks.

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ARVANITI, Pinelopi, OLIVAS, Ignasi, PASCUAL-DAPENA, Ana, RIVEIRO-BARCIELA, Mar, ESTEBAN, Paula, AGUILAR, Anna, PEREZ-MEDRANO, Indhira, HORTA, Diana, CABALLERO MARCOS, Arancha, SALCEDO, Magdalena, CONDE, Isabel, GOMEZ, Elena, CASTELLO, Inmaculada, BARBARA, Jesus santa, DIAZ-GONZALEZ, Alvaro, DEL BARRIO, Maria, LORENTE, Sara, MATEOS, Beatriz, ARENCIBIA, Ana, JIMENEZ, Miguel, CUENCA, Paqui, BERNAL-MONTERDE, Vanesa, FERNANDEZ, Eva-maria, RODRÍGUEZ TAJES, Sergio, POCURULL, Anna, HERNANDEZ EVOLE, Helena, FORNS BERNHARDT, Xavier, ANDRADE, Raul j, LONDOÑO HURTADO, María carlota. Unveiling Drug-Induced Autoimmune-Like Hepatitis in Autoimmune Hepatitis Patients: A Multicenter Retrospective Study. _Alimentary Pharmacology & Therapeutics_. 2025. Vol.  63, núm. 3, pàgs. 362-373. [consulta: 28 de febrer de 2026]. ISSN: Arvaniti, Pinelopi; Olivas, Ignasi; Pascual-Dapena, Ana; Riveiro-Barciela, Mar; Esteban, Paula; Aguilar, Anna; Perez-Medrano, Indhira; Horta, Diana; C (2025). Unveiling Drug-Induced Autoimmune-Like Hepatitis in Autoimmune Hepatitis Patients: A Multicenter Retrospective Study. Alimentary Pharmacology & Therapeutics, 63(3), 362-373. DOI: 10.1111/apt.70353. [Disponible a: https://hdl.handle.net/2445/227617]

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