Pharmacotherapies for Drug-Induced Liver Injury: A Current Literature Review

Abstract

Drug-induced liver injury (DILI) has become a serious public health problem. For the management of DILI, discontinuation of suspicious drug or medicine is the first step, but the treatments including drugs and supporting approaches are needed. Reference to clinical patterns and disease severity grades of DILI, the treatment drugs were considered to summarize into hepatoprotective drugs (N-acetylcysteine and Glutathione, Glycyrrhizin acid preparation, Polyene phosphatidylcholine, Bicyclol, Silymarin), anticholestatic drug (Ursodeoxycholic acid, S-adenosylmethionine, Cholestyramine), immunosuppressants (Glucocorticoids) and specific treatment agents (L-carnitine, Anticoagulants). The current article reviewed the accumulated literature with evidence-based medicine researches for DILI in clinical practice. Also the drawbacks of the clinical studies involved in the article, unmet needs and prospective development for DILI therapy were discussed.

The NLRP3 Inflammasome in Non-Alcoholic Fatty Liver Disease and Steatohepatitis: Therapeutic Targets and Treatment

“…Glycyrrhizin is extracted from Glycyrrhiza glabra L. (liquorice), a traditional Chinese medicine, and has shown potential hepatoprotective effects in preclinical stage human and animal model studies ( Li M. et al, 2021 ). In a mouse model, glycyrrhizin regulated insulin sensitivity, lipid profiles, and glucose homeostasis to reduce NAFLD progression ( Sun et al, 2017 ).…”

Liraglutide Exerts Protective Effects by Downregulation of PPARγ, ACSL1 and SREBP-1c in Huh7 Cell Culture Models of Non-Alcoholic Steatosis and Drug-Induced Steatosis

“…Pathophysiological mechanisms have still not been fully elucidated. The Roussel Uclaf Causality Assessment Method (RUCAM) and liver biopsy may help clinicians better diagnose and differentiate DILI in clinical practice [ 1 ]. The majority of countries and regions around the world have also compiled lists of empirical DILI treatment strategies and established guidelines.…”

Editorial: chronic DILI and HILI – corticosteroid plus glycyrrhizin as standard therapy?

“…The list of potential pharmacotherapeuticals under discussion used in DILI patients is long and includes N‐acetylcysteine and glutathione, glycyrrhizin (GC), polyene phosphatidylcholine, bicyclol, silymarin and corticosteroids (CSs) 7 . Clearly, pharmacotherapeutical efficacy is still vague and requires confirmation by randomised controlled trials (RCTs) 7 . Therapy studies using CSs have provided controversial results, and consensus exists that a validated standard therapy for all DILI cases using CSs does not exist 7–9 .…”

“…7 Therapy studies using CSs have provided controversial results, and consensus exists that a validated standard therapy for all DILI cases using CSs does not exist. [7][8][9] More specifically, problems included observational rather than RCT design, comparison with historical controls, defining the best time starting CSs, the uncertainty of whether CSs may even trigger acute liver failure, and lack of data based on DILI cases assessed for causality with RUCAM. Consequently, the current use of CSs remained an individual case decision considering the contraindications of CSs.…”

“…7 Clearly, pharmacotherapeutical efficacy is still vague and requires confirmation by randomised controlled trials (RCTs). 7 Therapy studies using CSs have provided controversial results, and consensus exists that a validated standard therapy for all DILI cases using CSs does not exist. [7][8][9] More specifically, problems included observational rather than RCT design, comparison with historical controls, defining the best time starting CSs, the uncertainty of whether CSs may even trigger acute liver failure, and lack of data based on DILI cases assessed for causality with RUCAM.…”