Statins May Trigger Autoimmune Hepatitis

By Liz Highleyman

This past July, a study suggesting that statins -- a class of medications used to treat elevated blood cholesterol - were active against hepatitis C virus (HCV) generated considerable excitement within the hepatitis C community.

But statins are not without risk, as illustrated by a report in the September 2006 Journal of Clinical Gastroenterology indicating that statins may trigger autoimmune hepatitis.

While the causes of autoimmune hepatitis (a condition in which the immune system attacks the liver) are not well understood, various drugs appear to be potential triggers in some individuals.

Researchers from the University of Connecticut Health Center and Indiana University School of Medicine described 3 patients in whom, they said, "it is probable that statins initiated the development" of autoimmune hepatitis.

Cases

Two men (ages 47 and 51) and one woman (age 57) developed autoimmune hepatitis after starting statin therapy.

The patients developed positive titers of anti-nuclear antibodies, anti-smooth muscle antibodies (1/40 to 1/160), and hypergammaglobulinemia, all markers of autoimmune reactions.

Features of all 3 patients met the criteria for autoimmune hepatitis according to the International Autoimmune Hepatitis Panel.

Liver biopsies in all 3 patients showed varying stages of fibrosis and plasma cell infiltration compatible with autoimmune hepatitis.

The woman developed hepatitis presumably due to statins on 2 separate occasions, first in 1999 while taking simvastatin (Zocor), and then in 2001-2002 while taking atorvastatin (Lipitor); her hepatitis was severe and persisted even after discontinuing the medication.

In the 2 men as well, autoimmune hepatitis began after starting statins and persisted despite discontinuing the medications.

All 3 patients responded well to immunosuppressive therapy using prednisone plus azathioprine or else mycophenolate mofitil.

Conclusion

In addition to these 3 cases, the authors also reviewed 3 similar previously reported cases. They concluded that, taken together, the 6 cases "indicate that severe, ongoing autoimmune hepatitis on rare occasions can be triggered by statins."

While these case reports do not mean that it is dangerous to take statins if needed to control high blood cholesterol, it reinforces the general advice that all medication should be used with caution and in consultation with a healthcare provider. This recommendation is especially important for individuals with pre-existing liver disease such as hepatitis C.

Reference
V Alla, J Abraham, J Siddiqui, and others. Autoimmune hepatitis triggered by statins. Journal of Clinical Gastroenterology 40(8): 757-761. September 2006.