Citation

Shahbaz O, Mahajan S, Lewis JH. Expert Opin. Drug. Metab. Toxicol. 2017; 13(9): 935-951.

Affiliation

Department of Medicine, Division of Gastroenterology, Hepatology Section , Georgetown University Hospital , Washington , DC.

Copyright

(Copyright © 2017, Informa Healthcare)

DOI

10.1080/17425255.2017.1362391

PMID

28772086

Abstract

INTRODUCTION: More than 1500 papers on drug-induced liver injury (DILI) and herb-induced liver injury (HILI) were published in 2016, many of which have the potential to impact clinical practice. AREAS COVERED: Clinical studies and case series that lent themselves to new concepts or directions in diagnosing, preventing, and treating DILI were selected for inclusion. Epidemiology of DILI in large prospective registries was highlighted, including the US DILIN network and Spanish DILI registry. Causality assessment of drug and herbal hepatotoxicity remains challenging, as seen with cases of OxyELITE Pro (OEP). In 2016 new updates to the Roussel Uclaf Causality Assessment Method (RUCAM) were published to aid in the accuracy of diagnosing DILI and HILI. Among the most clinically relevant papers to appear dealt with toxicity of direct acting antivirals (DAAs) for hepatitis C, causing both direct hepatotoxicity as well as the potential for reactivation of hepatitis B; both of which received FDA warnings. New reports of established hepatotoxins were again discussed in 2016, including genetic risk factors for DILI with respect to antituberculous agents. The use of potential DILI biomarkers with acetaminophen-related liver injury as well as to diagnose and manage DILI in patients with pre-existing liver disease are moving towards more broad applications. EXPERT OPINION: 2016 marked a turning point in how much credence should be placed in the current causality assessment for DILI/HILI cases. Many recognized hepatotoxins are backed by a relatively few number of literature reports including those contained in the LiverTox website. Danan and Teschke make a strong case that an updated RUCAM should remain the gold standard for diagnosing DILI/HILI going forward, although the role of expert opinion and clinical judgment are often still needed in cases where RUCAM falls short. The field of chemoinformatics continues to evolve while we await a truly predictive and diagnostic DILI biomarker.

Language: en

Keywords

DILI; Drug-Induced Liver Injury; Hepatotoxicity; Hepatotoxins