title: Liraglutide-induced autoimmune hepatitis.
abstract: OBJECTIVE
  Use of incretin-based hypoglycemic agents is increasing, but safety data remain limited. We treated a woman with marker-negative autoimmune hepatitis associated with the glucagon-like peptide 1 agonist liraglutide.
  
  
  METHODS
  A young woman with type 2 diabetes mellitus and vitiligo presented with a 10-day history of acute hepatitis. Other than starting liraglutide therapy 4 months prior, she reported no changes in medication therapy and no use of supplements. At admission, aspartate aminotransferase level was 991 U/L; alanine aminotransferase level, 1123 U/L; total bilirubin level, 9.5 mg/dL; and international normalized ratio, 1.3. Results of a liver biopsy demonstrated interface hepatitis with prominent eosinophils and rare plasma cells. The patient's liraglutide therapy was withheld at discharge but her symptoms worsened. A second biopsy specimen revealed massive hepatic necrosis. She started oral prednisone therapy for presumed liraglutide-induced marker-negative autoimmune hepatitis.
  
  
  CONCLUSIONS
  This case represents, to our knowledge, the first report of liraglutide-induced autoimmune hepatitis. Hepatotoxicity may be an incretin analogue class effect with a long latency period. This case raises prescriber awareness about the potential adverse effects of glucagon-like peptide 1 agonists. Postmarketing studies are needed to define the hepatotoxic potential of these agents.
authors.affiliation: Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Emily
authors.initials: E
authors.lastname: Kern
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Lisa B
authors.initials: LB
authors.lastname: VanWagner
authors.affiliation: Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Guang-Yu
authors.initials: GY
authors.lastname: Yang
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Rinella
mesh_terms: D048909:Diabetes Complications / Q000139:chemically induced*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000009:adverse effects / Q000031:analogs & derivatives*; D019693:Hepatitis, Autoimmune / Q000209:etiology* / Q000473:pathology; D006801:Humans; D054795:Incretins / Q000009:adverse effects*; D000069450:Liraglutide; D008099:Liver / Q000187:drug effects / Q000473:pathology; D055815:Young Adult
chemical_list: D054795:Incretins; D000069450:Liraglutide; D052216:Glucagon-Like Peptide 1
references.citation: J Clin Epidemiol. 1993 Nov;46(11):1323-30
references.pmid: 8229110
references.citation: Intern Med. 2011;50(9):1015-20
references.pmid: 21532224
references.citation: J Hepatol. 2001 Apr;34(4):537-47
references.pmid: 11394653
references.citation: Hepatology. 2011 Sep 2;54(3):931-9
references.pmid: 21674554
references.citation: J Clin Endocrinol Metab. 2011 Jun;96(6):1695-702
references.pmid: 21450987
references.citation: Hepatology. 2010 Jun;51(6):2040-8
references.pmid: 20512992
references.citation: Nat Rev Gastroenterol Hepatol. 2011 Apr;8(4):202-11
references.pmid: 21386809
references.citation: Dig Dis Sci. 2012 Mar;57(3):610-24
references.pmid: 22187100
references.citation: Gastroenterology. 2008 Dec;135(6):1924-34, 1934.e1-4
references.pmid: 18955056
references.citation: Dig Dis Sci. 2011 Apr;56(4):958-76
references.pmid: 21327704
references.citation: Endocr Pract. 2013 Mar-Apr;19(2):327-36
references.pmid: 23598536
references.citation: Ann Intern Med. 2012 Feb 7;156(3):218-31
references.pmid: 22312141
references.citation: J Gastroenterol. 2008;43(12):951-8
references.pmid: 19107339