Drug-induced autoimmune hepatitis: A minireview

Table 3 Comparison between drug-induced autoimmune hepatitis and drug-induced liver injury

Clinical features	DIAIH	DILI
Demographics
Female, %	62%[37]	48% (P = 0.162)[37]
Age (yr), mean ± SD	57± 17[37]; 59 ± 17[22]	54 ± 18 (P = 0.550)[37]; 47 (P = 0.002)[22]
Clinical presentation
Jaundice, %	69%[37]; 68%[15]; 66%[16]	69% (P = 0.953)[37]; 56% (P = 0.4)[15]; 40%-47.6% (P = 0.2)[16]
Rash, %	4.5%[37]; 19%[15]	7.9% (P = 1.000)[37]; 22% (P = 0.7)[15]
Hepatocellular injury, %	92%[37]	57% (P = 0.002)[37]
Latency period (d), median (range)	65 (27-274)[37]; 277 (8-7032)[15]; 4 (1-9)[16]	27 (8-64) (P = 0.004)[37]; 100 (13-1572) (P = 0.03)[15]; 7-10 (5-50) (P = 0.7)[16]
Latency period (d), mean ± SD	143 ± 188[22]	32 ± 120 (P = 0.000)[22]
Culprit drug due to CAM, %	70%[22]	25% (P = 0.000)[22]
Biochemical results
ALT × ULN, mean ± SD	28 ± 19[37]	19 ± 22 (P = 0.0002)[37]
AST × ULN, mean ± SD	24 ± 17[37]	15 ± 21 (P = 0.0001)[37]
Autoimmune antibodies and serology
Detectable ANA, %	88%[37]; 72%[15]; 52%[22]	12 (P < 0.001)[37]; 22[15]; 15 (P = 0.003)[22]
Detectable ASMA, %	44%[37]; 60%[15]	8.9% (P < 0.001)[37]; 13%[15]
Detectable AMA, %	4%[37]	1.9% (P = 0.397)[37]
Detectable anti-LKM-1, %	0%[37]	1.1% (P = 1.000)[37]
Elevated IgG, %	39%[15]; (25% > 1.1 × ULN)[15]	9%[15]
Serum IgG (g/L), mean ± SD	19.5 ± 10.7[37]; 1.07 × ULN ± 0.51[22]	11.9 ± 4.6 (P < 0.001)[37]; 0.69 × ULN ± 0.28 (P = 0.000)[22]
Histopathology
Liver biopsy[16]
Severe portal inflammation, %	100%	56.2%-62.5%
Prominent portal plasma cells, %	58.3%	6.3%-12.5%
Rosette formation, %	66.7%	6.3%-12.5%
Severe focal necrosis, %	66%	6.3%-25%
Treatment and response to treatment
Corticosteroid therapy, %	43%[15]	61% (P = 0.3)[15]
Immunosuppressive therapy, (corticosteroid/Azathioprine), %	58%[37]; 60.8%[22]	9.9% (P < 0.001)[37]; 10.3% (P = 0.000)[22]
Outcomes
Mild/mod/severe DILI, %	35%/45%/7.7%[37]	31%/59%/6.2% (P = 0.784)1[37]
Outcomes (liver transplant/death), %	3.8%/0%[37]; 6%/4%[15]	2.1%/1.5% (P = 0.784)1[37]; 0/0 (P = 0.6 for liver transplant, P = 1.0 for death)[15]
Chronicity rate, %	17%[15]	21% (P = 0.70)[15]

¹Combined comparisons of severity of drug-induced liver injury, mortality, and liver transplantation.

DIAIH: Drug-induced autoimmune hepatitis; DILI: Drug-induced liver injury; ALT: Alanine transaminase; AST: Aspartate transaminase; ULN: Upper limit of normal; CAM: Complementary alternative medicines; Anti-LKM: Anti-liver kidney antibody; SD: Standard deviation; IAIHG: International AIH Group.