Review article: Drug-induced liver injury in clinical practice

Einar Bjornsson (1)

1 Department of Internal Medicine

Background Drug induced liver injury (DILI) is an important differential diagnosis in many patients in clinical hepatology. DILI is the leading cause of acute liver failure and is an important safety issue when new drugs are developed. Aims To provide a review of the recent data on DILI with particular focus on the most common and relevant issues seen in clinical practice. Methods A Medline search was undertaken in order to identify relevant literature using search terms including “drug-induced liver injury”, “hepatotoxicity” and “adverse liver reactions” Results The true incidence of DILI is unknown but incidence up to 14 cases per 100 000 inhabitants and year have been reported. Antibiotics, analgetics and NSAIDs are the most common drugs causing liver injury. Idiosyncratic DILI has been shown to have a dose dependent component and drugs without significant hepatic metabolism rarely cause DILI. Chronic elevation in liver enzymes can develop after DILI but this is rarely associated with clinical morbidity or mortality. Conclusions Drug-induced liver injury remains a diagnostic challenge. Multicenter studies and International collaborative work with well characterized patients will increase our understanding of liver injury associated with drugs. New therapies for acute liver failure due to drugs are needed.

Mots clés: Medicine

Einar Bjornsson. Review article: Drug-induced liver injury in clinical practice. Alimentary Pharmacology and Therapeutics, 2010, ⟨10.1111/j.1365-2036.2010.04320.x⟩. ⟨hal-00552558⟩