IDIOSYNCRATIC DRUG-INDUCED LIVER INJURY: DIAGNOSIS AND TREATMENT
https://doi.org/10.21518/2079-701X-2017-5-100-107
Abstract
Drug-induced drug liver lesion (DILL) means the pathology of a wide spectrum – from clinically asymptomatic laboratory changes in liver function tests to fulminant acute hepatic insufficiency as a result of application of drugs, herbs or dietary supplements. There are two main options of DILL when direct (dose-dependent) and indirect damage (idiosyncratic) effect is exerted. Direct damage DILL cases are predictable, the more rare idiosyncratic variant can appear quite unexpectedly. Idiosyncratic DILL is more complex to diagnose and treat. The most common reason for DILL are use of antibiotics, nonsteroidal anti-inflammatory drugs and immunosuppressants. The diagnosis of DILL is stated by a mehod of elimination. The treatment begins with the immediate discontinuation of the administration of drugs, herbal medication or dietary supplements that can cause liver damage. There are no specific antidotes for the treatment of idiopathic DILL, symptomatic treatment is administered. In case of cholestasis ursodeoxycholic acid is often used. With the development of acute liver failure the positive forecast is significantly improved only by liver transplantation.
About the Authors
S. I. PimanovBelarus
MD, Prof.
E. V. Makarenko
Belarus
MD, Prof.
References
1. Licata A. Adverse drug reactions and organ damage: The liver. Eur J Intern Med, 2016, 28: 9-16.
2. Ильченко Л.Ю., Корович Т.И. Лекарственная болезнь печени. Медицинский совет, 2013; 10: 32-37.
3. Галимова С.Ф. Лекарственные поражения печени (Часть 1-я). Российский журнал гастроэнтерологии, гепатологии, колопроктологии, 2012, 3: 38-48.
4. Галимова С.Ф. Лекарственные поражения печени (Часть 2-я). Российский журнал гастроэнтерологии, гепатологии, колопроктологии, 2014, 1: 21-28.
5. Bjornsson ES. Epidemiology and risk factors for idiosyncratic drug-induced liver injury. Semin Liver Dis, 2014, 34(2): 115-122.
6. Chalasani NP, Hayashi PH, Bonkovsky HL et al. ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol, 2014, 109(7): 950-966.
7. Kuntz E,•Kuntz H-D. Hepatology. Principles and Practice. Heidelberg: Springer Medizin Verlag, 2006. 906 p.
8. Bjornsson ES. Drug-induced liver injury: an overview over the most critical compounds. Arch Toxicol, 2015, 89(3): 327-334.
9. Daly A. Pharmacogenomics of adverse events. Gend Med, 2013, 5(5): 2-12.
10. Fontana RJ. Pathogenesis of idiosyncratic druginduced liver injury and clinical perspective. Gastroenterology, 2014, 146(4): 914-928.
11. Devarbhavi H. An Update on Drug-induced Liver Injury. J Clin Exp Hepatol, 2012, 2: 247-259.
12. Пиманов С.И. Декомпенсированный цирроз печени: лечение с учетом международных рекомендаций. М.: Практическая медицина, 2016. 88 с.
13. Bechmann LP , Jochum C , Kocabayoglu P et al. Cytokeratin 18-based modify cation of the MELD score improves prediction of spontaneous survival after acute liver injury. J Hepatology, 2010, 53: 639-647.
14. Reuben A. Hy’s Law explaned. US FDA, 2008. https://www.fda.gov/downloads/drugs/scienceresearch/researchareas/ucm076783.pdf
15. Temple RJ. How Predictive Is Hy’s Law. FDA, 2014. https://www.aasld.org/sites/default/files/documents/2014/IA_2_Temple.pdf.
16. Wree A, Dechкne A, Herzer K et al. Steroid and Ursodesoxycholic Acid Combination Therapy in Severe Drug-Induced Liver Injury. Digestion, 2011, 84: 54-59.
17. Lee WM, Hynan LS, Rossaro L et al. Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology, 2009, 137: 856-864.
18. Chalasani N, Fontana RJ, Bonkovsky HL et al. Causes, clinical features, and outcomes from a prospective study of drug induced liver injury in the United States . Gastroenterology, 2008, 135: 1924-1934.
19. Beuers U, Boberg KM., Chapman RW et al. EASL Clinical Practice Guidelines: management of cholestatic liver diseases. J Hepatol, 2009, 51(2): 237-267.
20. Kong X, Kong Y, Zhang F et al. Evaluating the effectiveness and safety of ursodeoxycholic acid in treatment of intrahepatic cholestasis of pregnancy A meta-analysis (a prisma-compliant study). Medicine, 2016, 95(40): 1-9.
21. Saito Z, Kaneko Y, Kinoshita A et al. Effectiveness of hepatoprotective drugs for anti-tuberculosis drug-induced hepatotoxicity: a retrospective analysis. BMC Infectious Diseases, 2016, 16: 668.
22. Nathwani RA, Kaplowitz N. Drug hepatotoxicity. Clin Liver Dis, 2006, 10: 207-217.
23. http://www.rlsnet.ru/tn_index_id_41902.htm
Review
For citations:
Pimanov SI, Makarenko EV. IDIOSYNCRATIC DRUG-INDUCED LIVER INJURY: DIAGNOSIS AND TREATMENT. Meditsinskiy sovet = Medical Council. 2017;(5):100-107. (In Russ.) https://doi.org/10.21518/2079-701X-2017-5-100-107