Drug-induced liver injury.
- Andrade RJ Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Malaga, Spain. andrade@uma.es.
- Chalasani N Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA.
- Björnsson ES Department of Gastroenterology, Landspitali University Hospital Reykjavik, University of Iceland, Reykjavík, Iceland.
- Suzuki A Gastroenterology, Duke University, Durham, NC, USA.
- Kullak-Ublick GA Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Watkins PB UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
- Devarbhavi H Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, India.
- Merz M Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Lucena MI Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. lucena@uma.es.
- Kaplowitz N Division of Gastroenterology and Liver Diseases, Department of Medicine, Keck School of Medicine, Los Angeles, CA, USA.
- Aithal GP National Institute for Health Research (NIHR) Nottingham Digestive Diseases Biomedical Research Centre, Nottingham University Hospital NHS Trust and University of Nottingham, Nottingham, UK.
- 2019-08-24
Published in:
- Nature reviews. Disease primers. - 2019
English
Drug-induced liver injury (DILI) is an adverse reaction to drugs or other xenobiotics that occurs either as a predictable event when an individual is exposed to toxic doses of some compounds or as an unpredictable event with many drugs in common use. Drugs can be harmful to the liver in susceptible individuals owing to genetic and environmental risk factors. These risk factors modify hepatic metabolism and excretion of the DILI-causative agent leading to cellular stress, cell death, activation of an adaptive immune response and a failure to adapt, with progression to overt liver injury. Idiosyncratic DILI is a relative rare hepatic disorder but can be severe and, in some cases, fatal, presenting with a variety of phenotypes, which mimic other hepatic diseases. The diagnosis of DILI relies on the exclusion of other aetiologies of liver disease as specific biomarkers are still lacking. Clinical scales such as CIOMS/RUCAM can support the diagnostic process but need refinement. A number of clinical variables, validated in prospective cohorts, can be used to predict a more severe DILI outcome. Although no pharmacological therapy has been adequately tested in randomized clinical trials, corticosteroids can be useful, particularly in the emergent form of DILI related to immune-checkpoint inhibitors in patients with cancer.
- Language
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- English
- Open access status
- green
- Identifiers
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- DOI 10.1038/s41572-019-0105-0
- PMID 31439850
- Persistent URL
- https://sonar.ch/global/documents/47843
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