Volume 53, Issue 11 pp. 1073-1083

ORIGINAL ARTICLE

Long-term outcomes of drug-induced autoimmune-like hepatitis after pulse steroid therapy

Masayuki Ueno,

Corresponding Author

Masayuki Ueno

[email protected]

Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan

Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

Correspondence

Masayuki Ueno, Department of Gastroenterology and Hepatology, Kurashiki Central Hospital 1-1-1 Miwa, Okayama 710-8602, Japan.

Email: [email protected]

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Hiroyuki Takabatake,

Hiroyuki Takabatake

Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan

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Takahisa Kayahara,

Takahisa Kayahara

Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan

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Youichi Morimoto,

Youichi Morimoto

Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan

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Kenji Notohara,

Kenji Notohara

Department of Anatomic Pathology, Kurashiki Central Hospital, Kurashiki, Japan

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Motowo Mizuno,

Motowo Mizuno

Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan

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Masayuki Ueno,

Corresponding Author

Masayuki Ueno

[email protected]

Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan

Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

Correspondence

Masayuki Ueno, Department of Gastroenterology and Hepatology, Kurashiki Central Hospital 1-1-1 Miwa, Okayama 710-8602, Japan.

Email: [email protected]

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Hiroyuki Takabatake,

Hiroyuki Takabatake

Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan

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Takahisa Kayahara,

Takahisa Kayahara

Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan

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Youichi Morimoto,

Youichi Morimoto

Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan

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Kenji Notohara,

Kenji Notohara

Department of Anatomic Pathology, Kurashiki Central Hospital, Kurashiki, Japan

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Motowo Mizuno,

Motowo Mizuno

Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan

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First published: 22 June 2023

https://doi.org/10.1111/hepr.13940

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Abstract

Aim

Pulse steroid therapy occasionally causes drug-induced autoimmune-like hepatitis (DI-ALH), but the long-term outcome of treated patients is not well known. In this study, we investigated the long-term outcomes of DI-ALH due to pulse steroid therapy.

Methods

We retrospectively reviewed the medical records of 405 patients treated with pulse high-dose methylprednisolone in Kurashiki Central Hospital. The frequency and clinicopathological characteristics of acute liver injury that occurred within 3 months after the therapy were analyzed. The diagnosis of DI-ALH was made according to the revised international autoimmune hepatitis group criteria.

Results

Among the 405 patients treated with methylprednisolone, 61 (15.1%) had acute liver injury after the pulse steroid therapy, and DI-ALH was diagnosed in five patients (1.2%). Absence of oral prednisolone tapering after the pulse steroid therapy was a significant risk factor for the subsequent development of DI-ALH (odds ratio 11.9; p = 0.017). One patient was treated with 3 days of intravenous methylprednisolone followed by oral prednisolone. Two patients were treated with glycyrrhizin followed by oral prednisolone due to ineffectiveness of glycyrrhizin. Remission was achieved with glycyrrhizin alone, and spontaneous remission without drug therapy occurred in one patient each. During the median follow-up period of 34 months, no relapse was evident in all the patients without maintenance therapy.

Conclusions

Pulse steroid therapy can cause DI-ALH, especially when subsequent prednisolone is not tapered. Prednisolone is effective for DI-ALH due to pulse steroid therapy, and can be safely withdrawn once remission is achieved.

Graphical Abstract

Among the 405 patients who received pulse steroid therapy, five patients (1.2%) developed drug-induced autoimmune-like hepatitis (DI-ALH). Prednisolone was effective for DI-ALH due to pulse steroid therapy and could be safely withdrawn once remission was achieved.

CONFLICT OF INTEREST STATEMENT

Authors declare no Conflict of Interests for this article.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Supporting Information

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Volume53, Issue11

November 2023

Pages 1073-1083