title: Autoimmune hepatitis and anti-tumor necrosis factor alpha therapy: A single center report of 8 cases.
abstract: This article describes cases of anti-tumor necrosis factor (TNF)-α-induced autoimmune hepatitis and evaluates the outcome of these patients in relation to their immunosuppressive strategy. A retrospective analysis of medical records was performed in our center, in order to detect cases of autoimmune hepatitis (AIH) associated with anti-TNF biologic agents. We describe and analyze eight cases of AIH following anti-TNF therapy, 7 with infliximab and 1 with adalimumab. A distinction should be made between induction of autoimmunity and clinically evident autoimmune disease. Liver biopsy is useful in detecting the role of the TNF-α antagonist in the development of AIH. The lack of relapse after discontinuing immunosuppressive therapy favors, as in this case series, an immune-mediated drug reaction as most patients with AIH have a relapse after treatment is suspended. Although AIH related to anti-TNF therapy is rare, a baseline immunological panel along with liver function tests should be performed in all patients with autoimmune disease before starting biologics.
authors.affiliation: Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Rodrigues
authors.affiliation: Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Lopes
authors.affiliation: Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Magro
authors.affiliation: Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
authors.forename: Hélder
authors.initials: H
authors.lastname: Cardoso
authors.affiliation: Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Horta e Vale
authors.affiliation: Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Marques
authors.affiliation: Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
authors.forename: Eva
authors.initials: E
authors.lastname: Mariz
authors.affiliation: Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Bernardes
authors.affiliation: Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
authors.forename: Joanne
authors.initials: J
authors.lastname: Lopes
authors.affiliation: Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
authors.forename: Fátima
authors.initials: F
authors.lastname: Carneiro
authors.affiliation: Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Guilherme Macedo, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Macedo
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D001688:Biological Products / Q000009:adverse effects*; D005260:Female; D019693:Hepatitis, Autoimmune / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000069285:Infliximab / Q000009:adverse effects*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011174:Portugal; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D001688:Biological Products; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Adalimumab; Anti-tumor necrosis factor antagonist; Autoimmune hepatitis; Drug-induced liver injury; Inflammatory bowel disease; Infliximab