[Autoimmune hepatitis induced by fibrates].
OBJECTIVE
Long term treatment by fibrates could induce chronic hepatitis associated with auto-antibodies. The aim of this study was to assess the features of this hepatitis.


METHODS
Baseline clinical and biological features, and liver biopsy in 5 patients with fibrate-induced chronic hepatitis were studied, as well as their outcome.


RESULTS
At enrollment, patients (4 men, mean age 65 years) had highly (n = 3) or mildly (n = 2) increased serum aminotransferase activity, hypergammaglobulinemia and high titers of anti-nuclear antibodies (with homogenous fluorescence in 3 cases). Liver biopsies demonstrated a lympho-plasmocytic infiltrate in all cases. Hepatocellular necrosis was multilobular in 2 cases, and mild to moderate, located in lobular and periportal areas in 3 cases. Cirrhosis was found at presentation in 3 cases and developed within a few months in the 2 other patients. After discontinuation of fibrates, aminotransferase activity normalized within 6 weeks either spontaneously (n = 3) or under immunosuppressive treatment (n = 2). Immunosuppression was rapidly withdrawn in 2 patients (< 18 months) without relapse, while one patient was treated for 4 years because of relapse after early withdrawal. A second liver biopsy performed 6 months after discontinuation of fibrates in an untreated-patient showed no inflammation or necrosis.


CONCLUSIONS
These observations suggest that fibrates could trigger chronic liver disease resembling type I auto-immune chronic hepatitis, which resolves after drug withdrawal.
Service d'Hépato-Gastroentérologie, Hôpital Jean-Verdier, Bondy.
N
N
Ganne-Carrié
A
A
de Leusse
C
C
Guettier
L
L
Castera
H
H
Levecq
H J
HJ
Bertrand
Y
Y
Plumet
J C
JC
Trinchet
M
M
Beaugrand
D000368:Aged; D001327:Autoimmune Diseases / Q000139:chemically induced*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000276:immunology*; D002995:Clofibric Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D011345:Fenofibrate / Q000009:adverse effects*; D058607:Fibric Acids; D006801:Humans; D000960:Hypolipidemic Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged
D058607:Fibric Acids; D000960:Hypolipidemic Agents; D002995:Clofibric Acid; C019304:ciprofibrate; D011345:Fenofibrate
Hépatites d'allure auto-immune induites par les fibrates.