Rodrigues S, Lopes S, Magro F, Cardoso H, Horta e Vale AM, Marques M, Mariz E, Bernardes M, Lopes J, Carneiro F, Macedo G. Autoimmune hepatitis and anti-tumor necrosis factor alpha therapy: A single center report of 8 cases. World J Gastroenterol 2015; 21(24): 7584-7588 [PMID: 26140007 DOI: 10.3748/wjg.v21.i24.7584]
Corresponding Author of This Article
Guilherme Macedo, MD, PhD, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal. guilhermemacedo59@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
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Rodrigues S, Lopes S, Magro F, Cardoso H, Horta e Vale AM, Marques M, Mariz E, Bernardes M, Lopes J, Carneiro F, Macedo G. Autoimmune hepatitis and anti-tumor necrosis factor alpha therapy: A single center report of 8 cases. World J Gastroenterol 2015; 21(24): 7584-7588 [PMID: 26140007 DOI: 10.3748/wjg.v21.i24.7584]
World J Gastroenterol. Jun 28, 2015; 21(24): 7584-7588 Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7584
Autoimmune hepatitis and anti-tumor necrosis factor alpha therapy: A single center report of 8 cases
Susana Rodrigues, Susana Lopes, Fernando Magro, Hélder Cardoso, Ana Maria Horta e Vale, Margarida Marques, Eva Mariz, Miguel Bernardes, Joanne Lopes, Fátima Carneiro, Guilherme Macedo
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
Eva Mariz, Miguel Bernardes, Department of Rheumatology, Centro Hospitalar de São João, 4200-319 Porto, Portugal
Joanne Lopes, Fátima Carneiro, Department of Pathology, Centro Hospitalar de São João, 4200-319 Porto, Portugal
Fátima Carneiro, Institute of Molecular Pathology and Immunology at the University of Porto, 4200-319 Porto, Portugal
Author contributions: Rodrigues S study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; Lopes S analysis and interpretation of data; critical revision of the manuscript for important intellectual content; Magro F study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; Cardoso H, Horta e Vale AM, Marques M, Mariz E, Bernardes M and Lopes J analysis and interpretation of data; Carneiro F and Macedo G critical revision of the manuscript for important intellectual content.
Ethics approval: This manuscript is of a case series and not a formal study with a protocol, therefore no submission was made to the Hospital Ethics Review Board.
Informed consent: I hereby declare that all the patients included in the case series were aware that the cases were being submitted for publication in a scientific journal and consented.
Conflict-of-interest: None of the authors of this manuscript have any conflicts of interest to declare.
Correspondence to: Guilherme Macedo, MD, PhD, Department of Gastroenterology, Centro Hospitalar de São João, 4200-319 Porto, Portugal. guilhermemacedo59@gmail.com
Telephone: +351-225-512100 Fax: +351-225-025766
Received: October 6, 2014 Peer-review started: October 6, 2014 First decision: October 29, 2014 Revised: November 24, 2014 Accepted: January 30, 2015 Article in press: January 30, 2015 Published online: June 28, 2015 Processing time: 266 Days and 14 Hours
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.
Core tip: A total of 8 patients with anti-tumor necrosis factor (TNF)-α-induced autoimmune hepatitis were detected in a single center with over 600 patients. The authors raise the question as to whether most cases represent autoimmune-like drug-induced liver injury (DILI) or defined autoimmune hepatitis (AIH) as the majority of patients responded favorably to steroids and did not require maintenance therapy corresponding to the former. Although anti-TNF therapy-related AIH is rare, a baseline immunological panel along with liver function tests should be performed in all patients with autoimmune disease before starting biologics, in order to detect undiagnosed AIH or help differentiate between DILI and established AIH.
