Risk levels of herb-induced liver injury in Korea: from a meta-analysis

Abstract

Background As the use of herbal medicines increased worldwide, there has been concern about the risk of herb-induced liver injury (HILI). Many clinical studies have assessed the risk of HILI in Korea. Methods Therefore, we conducted a meta-analysis of the incidence of HILI in Korea, by analyzing nine clinical studies. These involved 8625 participants (3274 males; 5351 females), including 436 outpatients (three studies) and 8189 inpatients (six studies). Results As a result, the overall incidence of HILI in Korea was 0.49% (95% CI 0.33–0.74%), and it was 0.57% in males and 0.30% in females. We found a similar incidence of HILI in prospective (0.51%) and retrospective (0.50%) studies. The incidence of HILI was higher in inpatients (0.62%) than outpatients (0.03%). Conclusion Although there are limitations regarding study quality and the number of participants, we systematically estimated the risk of HILI in Korea. We anticipate this study would be a helpful information for prescribing herbal medicines and researching the safety of herbs.

Herb-Induced Liver Injury—A Challenging Diagnosis

“…Host-dependent risk factors are related to the consumer of herbal products and include factors such as age, sex, alcohol consumption, and chronic liver disease [ 14 , 17 , 19 , 52 , 55 , 57 ].…”

“…In the USA, the opposite happens, with women being more frequently affected than men [ 19 ]. In Korea, one study pointed to a higher incidence in males than in females [ 57 ]. However, another study in Korea showed just the opposite trend, with females having higher HILI incidence [ 45 ].…”

“…Quality is defined as the final product having the same therapeutic effects independently from which batch it is used [ 58 ]. Quality is affected by multiple factors, such as cultivation, harvesting, and manufacturing methods [ 57 , 58 , 59 ]. Producers must follow good agricultural practices and good manufacturing practices for herbal products to be safe and without quality issues [ 15 , 46 , 59 , 60 ].…”