Progress in our understanding of severe drug-induced liver injury

✍ Scribed by Paul H. Hayashi; Paul Watkins

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 55 KB
• Volume: 15
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21753

✦ Synopsis

Despite its low incidence, drug-induced liver injury (DILI) continues to have a high impact on the medical community, pharmaceutical industry, and general public. DILI is often difficult to diagnose, and few specific treatments are available. Severe DILI is the primary reason for regulatory actions on drugs, including failure to approve, "Dear Doctor" letters, and removal from the market. Such actions often deprive those who would otherwise benefit from these medications and increase drug development costs. At the individual level, drug-induced acute liver failure (DIALF) is often a devastating, sudden, and completely unexpected event for patients, loved ones, and physicians. The low incidence, lack of definitive diagnostic criteria for DILI, and varied array of medications that can lead to DIALF make clinical research difficult.

The study by Mindikoglu et al. 1 in this issue of Liver Transplantation expands on a previous examination of United Network for Organ Sharing (UNOS) data regarding causative agents for DILI resulting in liver transplantation. 2 The list of culprits and their distribution recorded by UNOS are similar to those reported by the Acute Liver Failure Study Group, 3 which includes DI-ALF patients who may or may not require liver transplantation, and by the Drug Induced Liver Injury Network, which enrolls patients with moderate and severe liver injury. 4 In aggregate, these provide a clearer picture of the more prevalent agents leading to severe DILI in the United States.

DILI has been clearly established as the leading cause