Table 4.
Comparison between drug-induced autoimmune hepatitis and autoimmune hepatitis
| Clinical features | DIAIH | AIH |
| Demographics | ||
| Female, % | 82%[32]; 91%[34] | 80% (P = 0.635)[32]; 92% (P = 0.95)[34] |
| Clinical presentation | ||
| Acute presentation | > 60%[14]; 55%[32]; 83%[34] | < 20%[14]; 47% (P = 0.618)[32]; 35% (P < 0.001)[34] |
| Hypersensitivity reaction (fever, rash, eosinophilia) | Up to 30%[14] | Unusual[14] |
| Cirrhosis at presentation, % | 0%[34] | 34.8% (P = 0.07)[34] |
| Temporal relationship with drugs | Positive | Negative |
| Concurrent AI disease | Unusual[14] | Present in 14%-44%[14] |
| Biochemical results | ||
| ALT (U/L), mean ± SD | 548 ± 335[20] | 227 ± 121 (P = 0.021)[20] |
| AST (U/L), mean ± SD | 460 ± 321[20] | 202 ± 57 (P = 0.018)[20] |
| Serology | ||
| IgG, mean ± SD (g/L) | 13.4 g/L[14]; 21.4 ± 7.5[34] | 18.6 g/L (P value non-significant)[14]; 24.3 ± 11.2 (P = 0.422)[34] |
| Pre-treatment score | ||
| RUCAM score, median (range) | 6 (3-10)[21] | 3.5 (0-7) (P < 0.01)[21] |
| Revised IAIHG score, median (range) | 9.5 (4-14)[21] | 13 (9-18)[21] |
| Simplified AIH score, median (range) | 4 (2-6)[21] | 5 (1-7) (P = 0.385)[21] |
| Histopathology | ||
| F3-F4, % | 33.3%[34] | 54.4% (P = 0.15)[34] |
| Typical histology (portal inflammation, interface hepatitis, plasma cells infiltrates) | 18.2%[20] | 54%[20] |
| Treatment and response to treatment | ||
| Time to biochemical remission, mean (mo) | 2[34] | 16.8 (P <0.001)[34] |
| Treatment with Azathioprine or Mycophenolic acid in addition to corticosteroids, % | 57%[13]; 15%[14]; 28%[20]; 20%[21] | 86% (P = 0.024)[13]; 83% (P < 0.001)[14]; 90% (P = 0.023)[20]; 85% (P < 0.01)[21] |
| Biochemical remission, % | 95%[21] | 77.3% (P = 0.08)[21] |
| Treatment discontinuation, % | 69%[14]; 100%[20]; 85%[21]; 25%[34] | 26% (P < 0.02)[14]; 25% (P = 0.013)[20]; 5% (P < 0.1)[21]; 3% (P < 0.001)[34] |
| Relapse rate, % | 0%[14]; 15%[21]; 60%[32]; 0%[34] | 43% (P = 0.022)[14]; 70% (P < 0.01)[21]; 83% (P = 0.538)[32]; 18% (P = 0.10)[34] |
| Time to relapse (wk), median (range) | 131 (37-216)[34] | 14 (1-155) (P = 0.033)[34] |
| Outcomes | ||
| Liver transplant/death, % | 0%/0%[32,34] | 2.8%/7% (P = 0.748 for liver transplant; p = 0.65 for death)[32]; 5.6%/2.8% (P = 0.40 for liver transplant; P = 0.55 for death)[34] |
DIAIH: Drug-induced autoimmune hepatitis; DILI: Drug-induced liver injury; ALT: Alanine transaminase; AST: Aspartate transaminase; RUCAM: The Roussel Uclaf Causality Assessment Model; SD: Standard deviation.