Distinction of Drug-Induced Liver Injury From Autoimmune Hepatitis in Patients With Acute Liver Injury: Proposal of a Combination of Diagnostic Scores

Kakisaka, Keisuke; Nakayama, Nobuaki; Kumagai, Kotaro; Hisanaga, Takuro; Kondo, Takayuki; Setsu, Toru; Sato, Shigeo; Kooka, Yohei; Endo, Kei; Yoshida, Yasuhiko; Oikawa, Takashi; Kuroda, Hidekatsu; Miyasaka, Akio; Abe, Ryuzo; Nakada, Taka‐aki; Harada, Kaoru; Genda, Takuya; Terai, Shuji; Kato, Naoya; Takami, Taro; Ido, Akio; Mochida, Satoshi; Matsumoto, Takayuki; Tanaka, Atsushi

doi:10.1016/j.gastha.2023.02.002

Cited by 1 publication

(1 citation statement)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…RUCAM helped search for pharmacotherapy options of iDILI including cases of a subtype characterized by serological autoimmune features and diagnosed as druginduced autoimmune hepatitis (DIAIH), for which corticosteroids are the first choice of treatment as shown in a study that applied the updated RUCAM to exclude competing causes [179], perfectly done by also using a specific diagnostic algorithm of genuine autoimmune hepatitis (AIH) [180] in a separate control cohort of AIH [179]. Differentiation of DIAIH from the usual DILI is commonly well achieved [179][180][181][182], even if the two diagnostic algorithms of iDILI and AIH were used in combination for DIAIH [181,182], but under these conditions, preference should be given to the updated RUCAM [181] rather than the original RUCAM [182]. RUCAM-based studies showed DIAIH causally related to drugs [183] like antimicrobials [184,185], atorvastatin [183], augmentin [184], ceftriaxone [185], diclofenac [186], direct oral anticoagulants [179], hydralazine [186], irbesartan [187], infliximab [188,189], isoniazid [186], ketoprofen [184], methyldopa [186], minocycline [186], nimesulide [184], nitrofurantoin [186,188,190,191], non-steroidal antiinflammatory drugs [179,184,190,192], sorafenib [183], and statins…”

Section: Rucam In Search For Pharmacotherapy Options Of Idilimentioning

confidence: 99%

Idiosyncratic DILI and RUCAM under One Hat: The Global View

Teschke,

Danan

2023

Livers

View full text Add to dashboard Cite

Drugs are prescribed worldwide to treat diseases but with the risk of idiosyncratic drug-induced liver injury (iDILI). The most important difficulty is how best to establish causality. Based on strong evidence and principles of artificial intelligence (AI) to solve complex processes through quantitative algorithms using scored elements, progress was achieved with the Roussel Uclaf Causality Assessment Method (RUCAM) in its original and updated versions, often viewed now as the gold standard. As a highly appreciated diagnostic algorithm, the RUCAM is in global use with around 100,000 iDILI cases published worldwide using RUCAM to assess causality, largely outperforming any other specific causality assessment tool in terms of case numbers. Consequently, the RUCAM helps to establish a list of top-ranking drugs worldwide implicated in iDILI and to describe clinical and mechanistic features of iDILI caused by various drugs. In addition, the RUCAM was recently applied in iDILI cases of patients treated for coronavirus disease 2019 (COVID-19) infections or cancer patients treated with immune checkpoint inhibitors (ICIs), as well as in the search for new treatment options with conventional drugs in iDILI. Analyses of RUCAM-based iDILI cases are helpful to support pathogenetic steps like immune reactions, genetic predisposition as evidenced by human leucocyte antigens (HLA) genotypes for selected drugs, and the role of the gut microbiome. To achieve consistency in data collection, analysis, and specific clinical and pathogenetic presentation, researchers, regulatory agencies, and pharmaceutical firms should place iDILI and the updated RUCAM as the causality tool under one and the same hat in review articles and clinical guidelines for the diagnosis and treatment of iDILI.

show abstract