Challenge of liver disease in systemic lupus erythematosus: Clues for diagnosis and hints for pathogenesis

Table 3 Hepatotoxicity induced by drugs used in lupus treatment

Drug	Liver injury and clinical significance
Corticosteroids	Hepatomegalia
	Fatty liver
NSAIDs	Asymptomatic ALT increase
	Hepatocellular, cholestatic, or mixed injury
ASA	Acute and chronic hepatocellular injury
	(resolve with withdrawal)
Methotrexate	Asymptomatic ALT increase at high doses
	Esteatosis, fibrosis, or cirrhosis
Anti-malarial drugs1	Rare hepatotoxic effects
	Porphyria cutanea tarda
Azatioprine	Cholestasis, peliosis, SOS, RNH
Thioguanine	SOS, RNH, portal hypertension
Ciclophosphamide	Rare case reports at conventional doses
	SOS at high doses (resolve with dose reduction)
Mycophenolate mofetil	Asymptomatic ALT increase
	(resolve with dose reduction)
Rituximab	No liver reactions have been reported
Belimumab	No liver reactions have been reported

¹Anti-malarial drugs: chloroquine, hydroxychloroquine. ALT: Alanine aminotransferase; NSAIDs: Non-steroidal antiinflamatory drugs; ASA: Acetylsalicilic acid; RNH: Nodular regenerative hyperplasia; SOS: Sinusoidal obstruction syndrome.