Role of Ursodeoxycholic Acid in Treating and Preventing Idiosyncratic Drug-Induced Liver Injury. A Systematic Review

Abstract

Introduction: Treatment is generally not available for drug-induced liver injury (DILI) patients except in some specific circumstances. The management of DILI is based on the withdrawal of the responsible drug and monitoring the patients and only a few patients need to be referred to a transplant center. Some studies on the role of ursodeoxycholic acid (UDCA) in DILI have been published. The aim of this study was to perform a systematic review of the role of UDCA in the treatment and prevention of DILI.Methods: A search was undertaken in PubMed, with the key words ursodeoxycholic acid, drug-induced liver injury and hepatotoxicity following the PRISMA guidelines.Results: A total of 33 publications were identified: 25 case reports and 8 case series. In 18 of the 25 cases reports (22 patients), authors reported improvement of liver injury associated with UDCA therapy whereas 7 case reports did not show clinical or biochemical improvement after UDCA treatment. There were 4 studies evaluating the role of UDCA in the treatment of DILI, three prospective (one being a clinical trial) and one retrospective studies. Three studies observed liver profile improvements associated with UDCA. In addition, four studies evaluated UDCA in the prevention of DILI: one pilot study, two randomized clinical trials (RCT) and one retrospective study. Three of these studies observed a lower percentage of patients with an increase in transaminases in the groups that used UDCA for DILI prevention.Conclusion: According to available data UDCA seems to have some benefits in the treatment and prevention of DILI. However, the design of the published studies does not allow a firm conclusion to be drawn on the efficacy of UDCA in DILI. A well designed RCT to evaluate the role of UDCA in DILI is needed.

A new framework for advancing in drug‐induced liver injury research. The Prospective European DILI Registry

“…In patients with acute liver failure due to DILI, emergency liver transplantation was undertaken in those without a contraindication for a liver transplant. There is currently no evidence based pharmacological treatment that can change the natural course of the liver injury in these patients as illustrated in three recent reviews on studies with ursodeoxycholic acid (40), nacetylcysteine (41) and corticosteroids (42) as well as well as a meta-analysis of studies on prevention and management of DILI (43). In clinical guideline from the European Association for the study of the liver (44) and the American College of Gastroenterology (45), patients with DI-AILH should be given corticosteroids if they do not show spontaneous improvement.…”

RAD-140 Drug-Induced Liver Injury

“…While our patient did not receive any specific treatment for his liver injury, ursodeoxycholic acid may be beneficial in relieving cholestasis related to drug-induced liver injury, although data are largely lacking. 13 Our patient had a history of using acetaminophen and salicylic acid prior to the onset of his liver injury. However, acetaminophen and/or salicylic acid-related hepatoxicity was deemed unlikely because of the small accumulated dosage, and more importantly, the lack of classic zone 3 necrosis/apoptosis and/or microvesicular steatosis.…”

“…While our patient did not receive any specific treatment for his liver injury, ursodeoxycholic acid may be beneficial in relieving cholestasis related to drug-induced liver injury, although data are largely lacking. 13 …”

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