DRUG-INDUCED AUTOIMMUNE HEPATITIS: SYSTEMATIC REVIEW AND CASE STUDY

Abstract

Drug-induced liver injury (DILI) is one of the types of adverse reactions to drugs that occur as a result of their hepatotoxic effect. The pathogenesis of drug-induced autoimmune hepatitis (LIAH) is based on the production of autoantibodies to neoantigens, which are proteins of the cytochrome P450 system, which are the result of the reaction of drug metabolites. A clinically relevant problem, such as drug-induced liver damage, affects 1-1.5 million patients almost every year. The annual incidence of DILI ranges from 2.3-13.9 per 100,000 population in population studies from Europe. The Icelandic population study recorded the highest rates of 19.1 per 100,000 population per year. And in the only study based on the US population, it was found that DILI is approximately 3 per 100,000 population. Acute hepatitis is currently a well-known manifestation, and accounts for more than 90% of liver damage caused by medications. According to studies, 2.9 - 8.8% of DILI and 2 - 18% of AIH are associated with drug-induced autoimmune hepatitis. The incidence of drug-induced liver damage with the presence of antibodies (antibodies to nuclear antigen, smooth muscle and soluble liver antigen) to AIH is 83% for nitrofurantoin, 74% for minocycline, 60% for methyldopa and 43% for hydralazine.