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CSH guidelines for the diagnosis and treatment of drug-induced liver injury.

ABSTRACT: Drug-induced liver injury (DILI) is an important clinical problem, which has received more attention in recent decades. It can be induced by small chemical molecules, biological agents, traditional Chinese medicines (TCM), natural medicines (NM), health products (HP), and dietary supplements (DS). Idiosyncratic DILI is far more common than intrinsic DILI clinically and can be classified into hepatocellular injury, cholestatic injury, hepatocellular-cholestatic mixed injury, and vascular injury based on the types of injured target cells. The CSH guidelines summarized the epidemiology, pathogenesis, pathology, and clinical manifestation and gives 16 evidence-based recommendations on diagnosis, differential diagnosis, treatment, and prevention of DILI.

SUBMITTER: Yu YC

PROVIDER: S-EPMC5419998 | biostudies-other | 2017 May

REPOSITORIES: biostudies-other

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CSH guidelines for the diagnosis and treatment of drug-induced liver injury.

Yu Yue-Cheng YC Mao Yi-Min YM Chen Cheng-Wei CW Chen Jin-Jun JJ Chen Jun J Cong Wen-Ming WM Ding Yang Y Duan Zhong-Ping ZP Fu Qing-Chun QC Guo Xiao-Yan XY Hu Peng P Hu Xi-Qi XQ Jia Ji-Dong JD Lai Rong-Tao RT Li Dong-Liang DL Liu Ying-Xia YX Lu Lun-Gen LG Ma Shi-Wu SW Ma Xiong X Nan Yue-Min YM Ren Hong H Shen Tao T Wang Hao H Wang Ji-Yao JY Wang Tai-Ling TL Wang Xiao-Jin XJ Wei Lai L Xie Qing Q Xie Wen W Yang Chang-Qing CQ Yang Dong-Liang DL Yu Yan-Yan YY Zeng Min-de MD Zhang Li L Zhao Xin-Yan XY Zhuang Hui H

Hepatology international 20170412 3

Drug-induced liver injury (DILI) is an important clinical problem, which has received more attention in recent decades. It can be induced by small chemical molecules, biological agents, traditional Chinese medicines (TCM), natural medicines (NM), health products (HP), and dietary supplements (DS). Idiosyncratic DILI is far more common than intrinsic DILI clinically and can be classified into hepatocellular injury, cholestatic injury, hepatocellular-cholestatic mixed injury, and vascular injury b ...[more]

PMID: 28405790

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Project description:Many drugs with different mechanisms of action and indications available on the market today are capable of inducing hepatotoxicity. Drug-induced liver injury (DILI) has been a treatment challenge nowadays as it was in the past. We searched Medline (via PubMed), CENTRAL, Science Citation Index Expanded, clinical trials registries and databases of DILI and hepatotoxicity up to 2021 for novel therapies for the management of adult patients with DILI based on the combination of three main search terms: 1) treatment, 2) novel, and 3) drug-induced liver injury. The mechanism of action of novel therapies, the potential of their benefit in clinical settings, and adverse drug reactions related to novel therapies were extracted. Cochrane Risk of bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment approach was involved in the assessment of the certainty of the evidence for primary outcomes of included studies. One thousand three hundred seventy-two articles were identified. Twenty-eight articles were included in the final analysis. Eight randomized controlled trials (RCTs) were detected and for six the available data were sufficient for analysis. In abstract form only we found six studies which were also anaylzed. Investigated agents included: bicyclol, calmangafodipir, cytisin amidophospate, fomepizole, livina-polyherbal preparation, magnesium isoglycyrrhizinate (MgIG), picroliv, plasma exchange, radix Paeoniae Rubra, and S-adenosylmethionine. The primary outcomes of included trials mainly included laboratory markers improvement. Based on the moderate-certainty evidence, more patients treated with MgIG experienced alanine aminotransferase (ALT) normalization compared to placebo. Low-certainty evidence suggests that bicyclol treatment leads to a reduction of ALT levels compared to phosphatidylcholine. For the remaining eight interventions, the certainty of the evidence for primary outcomes was assessed as very low and we are very uncertain in any estimate of effect. More effort should be involved to investigate the novel treatment of DILI. Well-designed RCTs with appropriate sample sizes, comparable groups and precise, not only surrogate outcomes are urgently welcome.

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CSH guidelines for the diagnosis and treatment of drug-induced liver injury.

Publications

CSH guidelines for the diagnosis and treatment of drug-induced liver injury.

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