AUTOIMMUNE HEPATITIS ASSOCIATED WITH FIBRATE TREATMENT

Aim. - Long term treatment by fibrates could induce chronic hepatitis associated with auto-antibodies. The aim of this study was to assess t he features of this hepatitis. Methods. - Baseline clinical and biolog ical features, and liver biopsy in 5 patients with fibrate-induced chr onic hepatitis were studied, as well as their outcome. Results. - At e nrollment, patients (4 men, mean age 65 years) had highly (n = 3) or m ildly (n = 2) increased serum aminotransferase activity, hypergammaglo bulinemia and high titers of anti-nuclear antibodies (with homogenous fluorescence in 3 cases). Liver biopsies demonstrated a lympho-plasmoc ytic infiltrate in all cases. Hepatocellular necrosis was multilobular in 2 cases, and mild to moderate, located in lobular and periportal a reas in 3 cases. Cirrhosis was found at presentation in 3 cases and de veloped within a few months in the 2 other patients. After discontinua tion of fibrates, aminotransferase activity normalized within 6 weeks either spontaneously (n = 3) or under immunosuppressive treatment (n = 2). Immunosuppression was rapidly withdrawn in 2 patients (< 18 month s) without relapse, while one patient Mas treated for 4 years because of relapse after early withdrawal. A second liver biopsy performed 6 m onths after discontinuation of fibrates in an untreated-patient showed no inflammation or necrosis. Conclusion. - These observations suggest that fibrates could trigger chronic liver disease resembling type I a uto-immune chronic hepatitis, which resolves after drug withdrawal.