Editorial: chronic DILI and HILI—corticosteroid plus glycyrrhizin as standard therapy? Authors' reply

Abstract

We would like to thank Rolf Teschke and Axel Eickhoff for their interest in our work investigating the efficacy and safety of corticosteroid (CS) plus glycyrrhizin (GC) therapy for chronic drug-or herb-induced liver injury (DILI/HILI). 1,2 Cessation of the suspected agent(s) is widely recommended and convincingly proved to reverse 80% DILI in the acute phase, 3,4 but this strategy seemed not contributable for patients in our study. It is worth to note that all the participants in two groups of this study have experienced drug cessation at least 6 months prior to therapy, suggesting they had already been patients with chronic DILI and drug cessation alone is not sufficient for DILI intervention. In addition, our study aimed to compare treatment outcome between strategies with and without CS in DILI patients with similar basal conditions, thus the drug cessation is unlikely a confounding factor that would influence our final conclusion. This clinical study is based on a prospectively registered and performed trial (NCT02651350), with randomised and open-labeled design, rather than a retrospective study. We started to recruit

Idiosyncratic DILI and RUCAM under One Hat: The Global View

“…A positive therapeutic effect was described in a study from China that perfectly used the updated RUCAM with scores ≥6, pre-defined thresholds of ALT and ALP, and exclusion of competing causes in liver injury cases with patients, who were treated with corticosteroids plus glycyrrhizin [202]. In this single-center randomized open-label trial, cases of DILI and HILI cases were included with separate evaluation of the two cohorts and their subgroups in line with CSH guidelines, recommending the use of the updated RUCAM in future trials with more patients, with some open questions that were clarified subsequently [203,204]. This prospective study from China also attracted the interest of another group working on the same topic but used a less straightforward approach [205] compared to the Chinese study [202].…”