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autoimmune hepatitis statin

Jonathan G Stine, Patrick G Northup
INTRODUCTION: Autoimmune-like drug-induced liver injury (DI-AIH) is a rare but serious event with a growing body of scientific evidence and a fair degree of uncertainty. AREAS COVERED: This review covers the definition, pathophysiology, treatment and patient-centered outcomes of DI-AIH and presents up-to-date information on the most commonly implicated drugs. EXPERT OPINION: A high degree of clinical suspicion is required for the diagnosis of DI-AIH...
July 21, 2016: Expert Opinion on Drug Metabolism & Toxicology
Alan T Clarke, Paul C D Johnson, Gillian C Hall, Ian Ford, Peter R Mills
BACKGROUND & AIMS: Occasional risk of serious liver dysfunction and autoimmune hepatitis during atorvastatin therapy has been reported. We compared the risk of hepatotoxicity in atorvastatin relative to simvastatin treatment. METHODS: The UK GPRD identified patients with a first prescription for simvastatin [164,407] or atorvastatin [76,411] between 1997 and 2006, but with no prior record of liver disease, alcohol-related diagnosis, or liver dysfunction. Incident liver dysfunction in the following six months was identified by biochemical value and compared between statin groups by Cox regression model adjusting for age, sex, year treatment started, dose, alcohol consumption, smoking, body mass index and comorbid conditions...
2016: PloS One
Treta Purohit, Mitchell S Cappell
Primary biliary cirrhosis (PBC) is an autoimmune, slowly progressive, cholestatic, liver disease characterized by a triad of chronic cholestasis, circulating anti-mitochondrial antibodies (AMA), and characteristic liver biopsy findings of nonsuppurative destructive cholangitis and interlobular bile duct destruction. About 10% of PBC patients, however, lack AMA. A variant, called PBC-autoimmune hepatitis (AIH) overlap, is characterized by the above findings of PBC together with findings of elevated serum alanine aminotransferase, elevated serum immunoglobulin G, and circulating anti-smooth muscle antibodies, with liver biopsy demonstrating periportal or periseptal, lymphocytic, piecemeal necrosis...
May 8, 2015: World Journal of Hepatology
Tian T Yeong, Kok H J Lim, Stephanie Goubet, Nick Parnell, Sumita Verma
AIM: Drug-induced autoimmune hepatitis (DIAIH) remains poorly characterized. Our aim was to assess natural history and outcomes in DIAIH. METHODS: This was a retrospective cohort study. RESULTS: Eighty-two patients with autoimmune hepatitis (AIH) were identified, 11 (13.4%) with DIAIH, implicated drugs being nitrofurantoin (n = 4), statins (n = 4), herbal remedies (n = 2) and diclofenac (n = 1). Female sex, acute onset, elevated serum globulins/immunoglobulin G, fibrosis stage (Ishak), cirrhosis at onset, moderate-severe portal inflammation, interface and lobular hepatitis, remission, relapse and poor outcome were similar in those with DIAIH and AIH (P > 0...
March 2016: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Danila Covelli, Guia Vannucchi, Irene Campi, Nicola Currò, Roberta D'Ambrosio, Marco Maggioni, Umberto Gianelli, Paolo Beck-Peccoz, Mario Salvi
CONTEXT: Intravenous glucocorticoids (IVGC) administered at high doses for the treatment of active moderate-severe Graves' orbitopathy (GO) may induce liver toxicity. Cumulative doses should not exceed 8 g and strict monitoring of liver function is recommended to avoid potentially life-threatening side effects. The 3-hydroxy-3-methylglutaryl-coenzyme reductase inhibitors, also known as statins, are employed to prevent major cardiovascular events. Patients with active GO, requiring immunosuppression with IVGC, are often treated with statins also...
May 2015: Journal of Clinical Endocrinology and Metabolism
Marcelo Alvarado Cárdenas, Ana Marín Sánchez, Joan Lima Ruiz
Statins are the most widely used drugs for both primary and secondary prevention of cardiovascular diseases and those associated with atherosclerosis. About 25 million people are on statin therapy in the world. Although they are well tolerated by most patients and have a safety profile, some patients have muscle level alterations. The biological effects associated with these drugs are known as pleiotropic; they are of such interest and diversity that explains, in part, some of the actions of statins, especially in relation to inflammation and the immune system...
November 6, 2015: Medicina Clínica
Tilman Sauerbruch, Jonel Trebicka
In patients with chronic liver disease, portal hypertension is driven by progressive fibrosis and intrahepatic vasoconstriction. Interruption of the initiating and perpetuating etiology-mostly leading to necroinflammation-is possible for several underlying causes, such as autoimmune hepatitis, hepatitis B virus (HBV) infection, and most recently hepatitis C virus (HCV) infection. Thus, in the long run, lifestyle-related liver damage due to chronic alcoholism or morbid obesity will remain the main factor leading to portal hypertension...
2014: F1000Prime Reports
E V Perdices, I Medina-Cáliz, S Hernando, A Ortega, F Martín-Ocaña, J M Navarro, G Peláez, A Castiella, H Hallal, M Romero-Gómez, A González-Jiménez, M Robles-Díaz, M I Lucena, R J Andrade
OBJECTIVES: The hepatotoxic potential of statins is controversial. The objectives of this study were to describe the relative frequency of hepatotoxicity caused by statins and the phenotypes found in Spain. PATIENTS AND METHODS: The incidence of hepatotoxicity attributed to statins in the Spanish Hepatotoxicity Registry (REH) were studied and compared with those attributed to other drugs. RESULTS: Between April 1994 and August 2012, the REH included a total of 858 cases of which 47 (5...
April 2014: Revista Española de Enfermedades Digestivas
Andrew S deLemos, David M Foureau, Carl Jacobs, Will Ahrens, Mark W Russo, Herbert L Bonkovsky
Drug-induced liver injury (DILI) with features of autoimmunity (AI) represents an important category of hepatotoxicity due to medication exposure. Drugs repeatedly associated with AI-DILI include diclofenac, α-methyl DOPA, hydralazine, nitrofurantoin, minocycline, and more recently statins and anti-TNF-α agents. Usually, symptoms of acute liver injury occur within a few months after initiation of a culprit medication, but a longer latency period is possible. Like idiopathic autoimmune hepatitis, circulating autoantibodies and a hypergammaglobulinemia are frequently present in sera from patients with AI-DILI...
May 2014: Seminars in Liver Disease
Agustin Castiella, Eva Zapata, M Isabel Lucena, Raúl J Andrade
The aetiology of autoimmune hepatitis (AIH) is uncertain but the disease can be triggered in susceptible patients by external factors such as viruses or drugs. AIH usually develops in individuals with a genetic background mainly consisting of some risk alleles of the major histocompatibility complex (HLA). Many drugs have been linked to AIH phenotypes, which sometimes persist after drug discontinuation, suggesting that they awaken latent autoimmunity. At least three clinical scenarios have been proposed that refers to drug- induced autoimmune liver disease (DIAILD): AIH with drug-induced liver injury (DILI); drug induced-AIH (DI-AIH); and immune mediated DILI (IM-DILI)...
April 27, 2014: World Journal of Hepatology
Harold Bays, David E Cohen, Naga Chalasani, Stephen A Harrison, The National Lipid Association's Statin Safety Task Force
In the 2006 Report of the National Lipid Association's Statin Safety Task Force, a panel of experts in hepatology published their findings on specific questions related to the liver blood testing during statin therapy. Among their recommendations was that regulatory agencies reconsider the statin-labeling recommendation at that time, which required post-statin liver enzyme testing. Since then, the Food and Drug Administration altered statin labeling such that unless clinically indicated for other reasons, after a pre-statin therapy baseline evaluation, follow-up liver enzyme testing was not uniformly required after statin initiation...
May 2014: Journal of Clinical Lipidology
Mark W Russo, Jay H Hoofnagle, Jiezhun Gu, Robert J Fontana, Huiman Barnhart, David E Kleiner, Naga Chalasani, Herbert L Bonkovsky
UNLABELLED: The HMG-CoA reductase inhibitors (statins) are widely prescribed for patients with hyperlipidemia and are generally well tolerated. Mild elevations in serum aminotransferases arise in up to 3% of treated patients, but clinically apparent drug-induced liver injury is rare. The aim of this study is to report the presenting features and outcomes of 22 patients with clinically apparent liver injury due to statins. Among 1,188 cases of drug-induced liver injury enrolled between 2004 and 2012 in a prospective registry by the U...
August 2014: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Jean Michel Petit, Samia Hamza, Fabien Rollot, Vanessa Sigonney, Elodie Crevisy, Laurence Duvillard, Jean Jacques Raab, Jean Pierre Bronowicki, Brigitte Bernard-Chabert, Vincent Di Martino, Michel Doffoel, Helene Barraud, Carine Richou, Jean Louis Jouve, Patrick Hillon
The association between liver cirrhosis (LC) and diabetes mellitus (DM) is well known. However, the impact of the severity or etiology of LC on the occurrence of DM is relatively unknown. We aimed to determine the prevalence and clinical correlates of DM in a large cohort of patients with cirrhosis. A total of 1,068 patients with LC were included in this cross sectional study (CIRCE study). The diagnosis of cirrhosis irrespective of its etiology was based on histological confirmation by liver biopsy or, in the absence of biopsy, on typical clinical, morphological and biological data...
2014: Acta Diabetologica
Santhosh G John, Jennifer Thorn, Richard Sobonya
Association of statins with autoimmune disorders is rarely reported. We report a case of an apparently healthy 76-year-old woman who was on long-term statin therapy presenting with severe rhabdomyolysis, autoimmune hepatitis, and positive lupus antibodies. Patient presented with complaints of worsening fatigue, leg cramps, and progressive weakening of lower extremities over 3 weeks. The patient was on simvastatin daily for several years. Clinical examination on admission included muscle tenderness, lower extremity edema, and ascites...
July 2014: American Journal of Therapeutics
Satoshi Nakayama, Naoya Murashima
Although statins are generally well-tolerated drugs, recent cases of autoimmune hepatitis (AIH) associated with their use have been reported. A 59-year-old Japanese man reported with liver damage, which appeared one month after beginning treatment with fluvastatin and continued after discontinuation of the drug. Although drug-induced liver injury was possible, positive autoantibody tests (antinuclear antibodies >1/1280, anti-mitochondrial M2 antibodies 21 index value) also suggested autoimmune liver disease...
March 2011: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
M Bruggisser, L Terraciano, A Rätz Bravo, M Haschke
We report the case of a 71-year-old male patient who presented at the emergency room with episodes of epistaxis and jaundice. The patient was on therapy with phenprocoumon, atorvastatin and perindopril. Findings on admission included prominent elevation of transaminases and bilirubin and a high INR due to impaired liver function and oral anticoagulation. After exclusion of other causes like viral or autoimmune hepatitis and after having obtained a liver biopsy, a diagnosis of drug induced liver damage (DILI) was made...
October 20, 2010: Praxis
Mark W Russo, Martin Scobey, Herbert L Bonkovsky
The "statins," or hydroxymethylglutaryl coenzyme A (HMG-CoA)-reductase inhibitors, are a generally safe class of drugs that are widely used throughout the world and are rarely associated with severe hepatotoxicity. In this article, two cases of severe hepatotoxicity attributed to statin use are presented. In addition, a detailed summary of previously published cases of statin hepatotoxicity and the risks and benefits of statins in patients with chronic liver disease are presented. Drug-induced liver injury (DILI) from statins typically presents with an acute hepatocellular liver injury pattern, although mixed or cholestatic injury patterns have also been reported...
November 2009: Seminars in Liver Disease
Jean-François Cadranel, Mimouna Seddik, Sylvia Loric, Sandrine Jeanne
Statins are among the most widely prescribed drugs throughout the industrialized world. Their benefits in primary and secondary prevention of cardiovascular events are undeniable. An asymptomatic increase in aminotransferase levels, generally less than 3 times the upper limit of normal range, is often observed in patients receiving statins. It is dose-dependent and often regresses even though treatment continues. A significant increase in aminotransferase levels is very rare in patients receiving statins Cases of hepatocellular, cholestatic, and mixed pattern liver injuries have been described, but severe hepatitis is rare...
May 2009: La Presse Médicale
B Noël
BACKGROUND: Statins have been increasingly associated with drug-induced autoimmune reactions, including lupus erythematosus. OBJECTIVE: To identify and determine the clinical and biological characteristics of statin-induced autoimmune reactions. MATERIAL AND METHODS: The MEDLINE database (1966 to September 2005) was used to identify all reported cases of statin-induced autoimmune diseases. The keywords used were statins, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, adverse effects, autoimmune disease, lupus erythematosus, dermatomyositis and polymyositis...
January 2007: Journal of the European Academy of Dermatology and Venereology: JEADV
Vamsee Alla, Joseph Abraham, Junaid Siddiqui, Dimple Raina, George Y Wu, Naga P Chalasani, Herbert L Bonkovsky
Although the cause of autoimmune hepatitis (AIH) is unknown, drugs are believed to be potential triggers in some patients. In isolated case reports, statins have been considered such triggers. Here we describe 3 patients in whom it is probable that statins initiated the development of AIH. Two men (aged 47 and 51) and one woman (aged 57) developed AIH after the initiation of statin therapy. They developed positive titers of antinuclear antibodies, antismooth muscle antibodies (1/40 to 1/160), and hypergammaglobulinemia...
September 2006: Journal of Clinical Gastroenterology
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