title: Natural history and outcomes in drug-induced autoimmune hepatitis.
abstract: OBJECTIVE
  Drug-induced autoimmune hepatitis (DIAIH) remains poorly characterized. Our aim was to assess natural history and outcomes in DIAIH.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  RESULTS
  Eighty-two patients with autoimmune hepatitis (AIH) were identified, 11 (13.4%) with DIAIH, implicated drugs being nitrofurantoin (n = 4), statins (n = 4), herbal remedies (n = 2) and diclofenac (n = 1). Female sex, acute onset, elevated serum globulins/immunoglobulin G, fibrosis stage (Ishak), cirrhosis at onset, moderate-severe portal inflammation, interface and lobular hepatitis, remission, relapse and poor outcome were similar in those with DIAIH and AIH (P > 0.05). The former were however more likely to be aged 60 years or more and take longer to relapse on immunosuppression discontinuation (P = <0.05). On Kaplan-Meier analysis, probability of poor outcome was similar in those with DIAIH and AIH (log-rank test, 0.339). On comparing those with (n = 4) and without nitrofurantoin (n = 7) DIAIH, the former were older, had longer duration of drug use prior to DIAIH diagnosis, higher fibrosis stage and were less likely to relapse upon immunosuppression discontinuation.
  
  
  CONCLUSIONS
  Approximately 15% of patients with AIH have DIAIH with similar outcomes, although the latter are older with a propensity for late relapse, mandating long-term follow up.
authors.affiliation: Departments of Medicine, Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Tian T
authors.initials: TT
authors.lastname: Yeong
authors.affiliation: Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK.
authors.forename: Kok H J
authors.initials: KH
authors.lastname: Lim
authors.affiliation: Clinical and Investigation Research Unit, Brighton and Sussex University Hospital, Brighton, UK.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Goubet
authors.affiliation: Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Parnell
authors.affiliation: Departments of Medicine, Brighton and Sussex Medical School, Brighton, UK.|Department of Gastroenterology and Hepatology, Brighton and Sussex University Hospital, Brighton, UK.
authors.forename: Sumita
authors.initials: S
authors.lastname: Verma
keywords: drug-induced liver injury; herbal remedies; nitrofurantoin; statins