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Diagnosis and Management of Drug-Induced Liver Injury (DILI) in Patients with Pre-Existing Liver Disease.
Drug Saf. 2016 08; 39(8):729-44.DS

Abstract

The relationship between drugs and pre-existing liver disease is complex, particularly when increased liver tests (LTs) or new symptoms emerge in patients with pre-existing liver disease during drug therapy. This requires two strategies to assess whether these changes are due to drug-induced liver injury (DILI) as a new event or due to flares of the underlying liver disease. Lacking a valid diagnostic biomarker, DILI is a diagnosis of exclusion and requires causality assessment by RUCAM, the Roussel Uclaf Causality Assessment Method, to establish an individual causality grading of the suspected drug(s). Flares of pre-existing liver disease can reliably be assessed in some hepatotropic virus infections by polymerase chain reaction (PCR) and antibody titers at the beginning and in the clinical course to ascertain flares during the natural course of the disease. Unfortunately, flares cannot be verified in many other liver diseases such as alcoholic liver disease, since specific tests are unavailable. However, such a diagnostic approach using RUCAM applied to suspected DILI cases includes clinical and biological markers of pre-existing liver diseases and would determine whether drugs or underlying liver diseases caused the LT abnormalities or the new symptoms. More importantly, a clear diagnosis is essential to ensure effective disease management by drug cessation or specific treatment of the flare up due to the underlying disease.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Department of Internal Medicine II, Klinikum Hanau, Leimenstrasse 20, 63450, Hanau, Germany. rolf.teschke@gmx.de. Academic Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, Frankfurt/Main, Germany. rolf.teschke@gmx.de.Pharmacovigilance Consultancy, Paris, France.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27091053

Citation

Teschke, Rolf, and Gaby Danan. "Diagnosis and Management of Drug-Induced Liver Injury (DILI) in Patients With Pre-Existing Liver Disease." Drug Safety, vol. 39, no. 8, 2016, pp. 729-44.
Teschke R, Danan G. Diagnosis and Management of Drug-Induced Liver Injury (DILI) in Patients with Pre-Existing Liver Disease. Drug Saf. 2016;39(8):729-44.
Teschke, R., & Danan, G. (2016). Diagnosis and Management of Drug-Induced Liver Injury (DILI) in Patients with Pre-Existing Liver Disease. Drug Safety, 39(8), 729-44. https://doi.org/10.1007/s40264-016-0423-z
Teschke R, Danan G. Diagnosis and Management of Drug-Induced Liver Injury (DILI) in Patients With Pre-Existing Liver Disease. Drug Saf. 2016;39(8):729-44. PubMed PMID: 27091053.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and Management of Drug-Induced Liver Injury (DILI) in Patients with Pre-Existing Liver Disease. AU - Teschke,Rolf, AU - Danan,Gaby, PY - 2016/4/20/entrez PY - 2016/4/20/pubmed PY - 2017/12/15/medline SP - 729 EP - 44 JF - Drug safety JO - Drug Saf VL - 39 IS - 8 N2 - The relationship between drugs and pre-existing liver disease is complex, particularly when increased liver tests (LTs) or new symptoms emerge in patients with pre-existing liver disease during drug therapy. This requires two strategies to assess whether these changes are due to drug-induced liver injury (DILI) as a new event or due to flares of the underlying liver disease. Lacking a valid diagnostic biomarker, DILI is a diagnosis of exclusion and requires causality assessment by RUCAM, the Roussel Uclaf Causality Assessment Method, to establish an individual causality grading of the suspected drug(s). Flares of pre-existing liver disease can reliably be assessed in some hepatotropic virus infections by polymerase chain reaction (PCR) and antibody titers at the beginning and in the clinical course to ascertain flares during the natural course of the disease. Unfortunately, flares cannot be verified in many other liver diseases such as alcoholic liver disease, since specific tests are unavailable. However, such a diagnostic approach using RUCAM applied to suspected DILI cases includes clinical and biological markers of pre-existing liver diseases and would determine whether drugs or underlying liver diseases caused the LT abnormalities or the new symptoms. More importantly, a clear diagnosis is essential to ensure effective disease management by drug cessation or specific treatment of the flare up due to the underlying disease. SN - 1179-1942 UR - https://www.unboundmedicine.com/medline/citation/27091053/Diagnosis_and_Management_of_Drug_Induced_Liver_Injury__DILI__in_Patients_with_Pre_Existing_Liver_Disease_ L2 - https://dx.doi.org/10.1007/s40264-016-0423-z DB - PRIME DP - Unbound Medicine ER -