Steroid and Ursodesoxycholic Acid Combination Therapy in Severe Drug-Induced Liver Injury

Abstract

Background: Drug-induced liver injury (DILI) is the leading cause of acute severe liver disease in Western countries. Treatment strategies for DILI are still not well defined. Aim: We studied the safety and outcomes of steroid/ursodesoxycholic acid (UDCA) combination therapy in DILI patients. Patients, Materials and Methods: 15 consecutive patients with severe DILI were analyzed for clinical, biochemical and histological data. Nine patients were treated with a steroid step-down therapy with reduction of the daily dose over several weeks; 6 patients received a steroid pulse therapy for 3 days. UDCA was administered for several weeks in both groups. Results: Patients without histological signs of preexistent liver damage (n = 10) showed the most favorable clinical course. Bilirubin and serum transaminases dropped to <50% of peak values within 2 weeks, and normalized within 4–8 weeks. In contrast, patients with positive autoimmune antibodies (anti-nuclear antibodies and/or soluble liver antigen) and/or histological features of chronic hepatitis (n = 3) exhibited a slower reduction in bilirubin and serum transaminase levels. These patients were given immunosuppressants (steroids, azathioprine) for a further 6 months. Conclusion: Treatment of severe DILI with corticosteroids (both pulse and step-down therapy) and UDCA appears to be safe, and leads to a more rapid reduction in bilirubin and transaminases after DILI.

The Art and Science of Diagnosing and Managing Drug-induced Liver Injury in 2015 and Beyond

“…In some cases this means discontinuing a drug that is efficacious, and in situations where there are no alternative agents, the patient may be deprived of a beneficial medication, especially if causality is in doubt (111). Some patients have received ursodiol or steroids in cases of cholestatic DILI, although such treatment has been met with only anecdotal success (70,73,206,244).…”

Acute and Fatal Isoniazid-Induced Hepatotoxicity: A Case Report and Review of the Literature

“…As for the appropriate management, the first step would be withdrawing the offending agent and, if possible, other hepatotoxic agents as well [32]. Corticosteroids and ursodeoxycholic acid have been proposed as a treatment for DILI associated with acute liver failure (ALF) [40]; however, no robust evidence supports these treatment modalities [32]. The use of intravenous N-acetylcysteine (NAC) in non-acetaminophen acute liver failure (DILI in one subgroup) was tested in a prospective, double blind trial.…”

Idiosyncratic Drug-Induced Liver Injury: Diagnosis and Treatment

“…Хорошие результаты были получены в неконтролируемом исследо-вании небольшого объема при лечении ЛПП (гепатит или ОПеН) лишь комбинацией УДХК и ГКС [16]. Больные полу-чали пульс-терапию ГКС в течение 3 дней или преднизо-лон 2-5 мг/кг/сут с последующим снижением дозы.…”