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The long-term follow-up after idiosyncratic drug-induced liver injury with jaundice

Björnsson, Einar, Davidsdottir, Loa·2009·Journal of Hepatology
DOI 10.1016/j.jhep.2008.10.021
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Abstract

Background/aims Chronic evolution after drug-induced liver injury (DILI) has been reported. How often this leads to liver-related morbidity and mortality is unexplored. Methods Patients who survived DILI and concomitant jaundice reported to the Swedish Adverse Drug Reaction Advisory Committee (1970-2004) were linked to the Swedish Hospital Discharge and Cause of Death Registries. Results Among the 712 survivors, 27 could not be retrieved but 685 patients could be linked to the registries, 392 females (57.2%) and 293 males (42.8%) median age 58 (41-74), a mean follow-up of 10 years. A total of 23/685 (3.4%) patients had been hospitalized for liver disease and 5 had liver-related mortality. Eight patients developed cirrhosis (7 decompensated, 5 died), 5 had "cryptogenic" cirrhosis in which DILI might have played a role in this development. Duration of therapy before DILI was longer in patients with liver-related morbidity/mortality (135+/-31 days vs. 53+/-3; p Conclusions Development of clinically important liver disease after severe DILI associated with jaundice is rare after acute DILI. However decompensated "cryptogenic" cirrhosis developed in some patients with fatal outcome in which DILI might have played a role in this development.

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  • In a retrospective longitudinal cohort of patients with drug-induced jaundice (n = 685), 3.4% (n = 23) of patients were hospitalised (during a mean follow-up of 10 years) of whom 22% (n = 5) developed AIH at 1.5 months to 6 years from the initial event and another five developed cryptogenic cirrhosis.

    “In a retrospective longitudinal cohort of patients with drug-induced jaundice (n = 685), 3.4% (n = 23) of patients were hospitalised (during a mean follow-up of 10 years) of whom 22% (n = 5) developed AIH at 1.5 months to 6 years from the initial event and another five developed cryptogenic cirrhosis.”

    From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [52]

  • Normalisation of liver tests in patients with DILI, either spontaneously or after immunosuppression, does not always guarantee a benign course.

    “Normalisation of liver tests, either spontaneously or after the use of immunosuppression, in patients with DILI does not always guarantee a benign course, highlighting the need for prolonged follow-up in case of AIH development after the resolution of DILI.52,77”

    From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [52]

  • DI-ALH presents as a self-limited phenotype that resolves or becomes quiescent when the drug is removed, but in some cases liver injury progresses to chronicity and a self-perpetuating autoimmune liver disease ensues.

    “Thus, DI-AHL presents as a “self-limited” phenotype that resolves or becomes quiescent when the drug is removed, but in some cases, liver injury does progress to chronicity and a “self-perpetuating” autoimmune liver disease ensues (Fig. 2).22,51,52”

    From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [52]

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Research works printed but not linked: 23

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Metadata

Authors
Björnsson, E., & Davidsdottir, L.
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2009-03
Volume
50
Issue
3
Pages
511-517
ISSN
0168-8278
DOI
10.1016/j.jhep.2008.10.021
Cited by
131
References
0
Language
en
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)

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