3 Key Takeaways
Plain English Summary- 01Core Finding
Amongst the 1983 high causality cases, median age was 52 years, 59% were female, 54% had hepatocellular injury and antibiotics (41%) were the leading drug class.
- 02Study Evidence
Tested in a observational cohort study at the real-world cohort stage.
- 03Practical Meaning
Observational cohort findings reveal real-world links, though lifestyle or unmeasured factors cannot be fully ruled out without an RCT.
What This Means for You
Over the past 20 years, a decreasing proportion of DILI cases are attributed to antibiotics while an increasing proportion are attributed to HDS products and antineoplastics. Oncology patients and those > 65 years old have significantly higher overall and liver-related mortality.
The Discovery
Idiosyncratic drug-induced liver injury (DILI) is an infrequent cause of liver disease. The aim of this study is to report on temporal changes in the etiology and outcomes of idiosyncratic DILI in the United States DILIN Prospective study. The presenting clinical features and outcomes of consecutive high causality DILI cases followed for 6 months at multiple DILIN sites from 2004 to 2024 were compared over time and by suspect drug class, age, sex, and prior chronic liver disease (CLD) status. Amongst the 1983 high causality cases, median age was 52 years, a clinically meaningful level were female, a clinically meaningful level had hepatocellular injury and antibiotics were the leading drug class. The median peak total bilirubin, INR and severity scores decreased significantly over time, as did the proportion of cases attributed to antimicrobials, including isoniazid and nitrofurantoin, and to central nervous system agents. In contrast, the proportion of herbal and dietary supplement (HDS) and antineoplastic drug cases (including checkpoint inhibitors), increased significantly. Patients with CLD had higher mortality compared to non-CLD patients. Pediatric patients presented more frequently with hepatocellular injury but had a lower overall and liver related mortality compared to adults. Oncology DILI patients had a 6-month mortality rate with most deaths attributed to non-liver related causes.
How It Works, Simply
This gastroenterology research focuses on immune checkpoint. Researchers evaluated it using an observational cohort study at the real-world cohort stage of medical research.
3 Key Takeaways
Clinical Takeaways- 01Core Finding
Amongst the 1983 high causality cases, median age was 52 years, 59% were female, 54% had hepatocellular injury and antibiotics (41%) were the leading drug class.
- 02Study Evidence
Tested in a observational cohort study at the real-world cohort stage.
- 03Practical Meaning
Observational cohort findings reveal real-world links, though lifestyle or unmeasured factors cannot be fully ruled out without an RCT.
Key Numbers
Biological Mechanism & Study Design
Study Design & Cohort
Observational cohort study
Observational cohort study · Real-World Cohort
Biological Pathway & Modality
Immune checkpoint
Intervention: Trends in the etiologies and outcomes of idiosyncratic drug-induced liver injury in
Experimental Findings & Endpoints
Idiosyncratic drug-induced liver injury (DILI) is an infrequent cause of liver disease.
The aim of this study is to report on temporal changes in the etiology and outcomes of idiosyncratic DILI in the United States DILIN Prospective study. The presenting clinical features and outcomes of consecutive high causality DILI cases followed for 6 months at multiple DILIN sites from 2004 to 2024 were compared over time and by suspect drug class, age, sex, and prior chronic liver disease (CLD) status.
Amongst the 1983 high causality cases, median age was 52 years, a clinically meaningful level were female, a clinically meaningful level had hepatocellular injury and antibiotics were the leading drug class. The median peak total bilirubin, INR and severity scores decreased significantly over time, as did the proportion of cases attributed to antimicrobials, including isoniazid and nitrofurantoin, and to central nervous system agents.
In contrast, the proportion of herbal and dietary supplement (HDS) and antineoplastic drug cases (including checkpoint inhibitors), increased significantly. Patients with CLD had higher mortality compared to non-CLD patients.
Pediatric patients presented more frequently with hepatocellular injury but had a lower overall and liver related mortality compared to adults. Oncology DILI patients had a 6-month mortality rate with most deaths attributed to non-liver related causes.
Clinical Translation & Practice Context
Over the past 20 years, a decreasing proportion of DILI cases are attributed to antibiotics while an increasing proportion are attributed to HDS products and antineoplastics.
Oncology patients and those > 65 years old have significantly higher overall and liver-related mortality.
The Bottom Line · Clinical Pearl
“Over the past 20 years, a decreasing proportion of DILI cases are attributed to antibiotics while an increasing proportion are attributed to HDS products and antineoplastics.”
Published in Hepatology (baltimore, Md.) · Current Stage: Real-World Cohort
