Contact: Aimee Frank
American Gastroenterological Association
Study finds CNS agents also commonly associated with drug-induced liver injury
MD (Dec. 1, 2008) – Antibiotics are the single largest class of agents
that cause idiosyncratic drug-induced liver injury (DILI), reports a
new study in
Gastroenterology, an official journal of the
American Gastroenterological Association (AGA) Institute. DILI is the
most common cause of death from acute liver failure and accounts for
approximately 13 percent of cases of acute liver failure in the U.S. It
is caused by a wide variety of prescription and nonprescription
medications, nutritional supplements and herbals.
"DILI is a
serious health problem that impacts patients, physicians, government
regulators and the pharmaceutical industry," said Naga P. Chalasani,
MD, of the Indiana University School of Medicine and lead author of the
study. "Further efforts are needed in defining its pathogenesis and
developing means for the early detection, accurate diagnosis,
prevention and treatment of DILI."
In this prospective,
ongoing, multi-center observational study — the largest of its kind —
patients with suspected DILI were enrolled based upon predefined
criteria and followed for at least six months. Those with acetaminophen
liver injury were excluded.
Researchers found that DILI was
caused by a single prescription medication in 73 percent of the cases,
by dietary supplements in 9 percent and by multiple agents in 18
percent. More than 100 different agents were associated with DILI;
antimicrobials (45.5 percent) and central nervous system agents (15
percent) were the most common. Of the dietary supplements causing DILI,
compounds that claim to promote weight loss and muscle building
accounted for nearly 60 percent of the cases. The study found that at
least 20 percent of patients with DILI ingest more than one potentially
DILI remains a diagnosis of exclusion and
thus detailed testing should be performed to exclude competing causes
of liver disease; importantly, acute hepatitis C virus (HCV) infection
should be carefully excluded in patients with suspected DILI by HCV RNA
testing. Researchers found no relationship between gender and severity
of DILI, but individuals with diabetes experienced more severe DILI.
This study is an
initial analysis of an ongoing prospective study of DILI. Its primary
aim is to develop well-characterized cases of medication-related liver
injury on which to conduct hypothesis-driven research targeted at
developing means to diagnose, prevent and treat DILI. DILI is the most
frequent adverse drug-related event leading to abandonment of
potentially promising new drug candidates during pre-clinical or
clinical development, failure to achieve drug approval, and withdrawal
or restriction of prescription drug use after approval.
Drug-Induced Liver Injury Network is funded by the National Institute
of Diabetes and Digestive and Kidney Diseases (NIDDK) and was
established in 2003 and will operate through 2013. It consists of eight
clinical centers, one data coordinating center and NIDDK investigators.
Visit http://dilin.dcri.duke.edu/ to learn more.
About the AGA Institute
The American Gastroenterological Association (AGA) is dedicated to
the mission of advancing the science and practice of gastroenterology.
Founded in 1897, the AGA is one of the oldest medical-specialty
societies in the U.S. Comprised of two non-profit organizations—the AGA
and the AGA Institute—our more than 16,000 members include physicians
and scientists who research, diagnose and treat disorders of the
gastrointestinal tract and liver. The AGA, a 501(c6) organization,
administers all membership and public policy activities, while the AGA
Institute, a 501(c3) organization, runs the organization's practice,
research and educational programs. On a monthly basis, the AGA
Institute publishes two highly respected journals,
Clinical Gastroenterology and Hepatology.
The organization's annual meeting is Digestive Disease Week®, which is
held each May and is the largest international gathering of physicians,
researchers and academics in the fields of gastroenterology,
hepatology, endoscopy and gastrointestinal surgery. For more
information, please visit www.gastro.org.
Gastroenterology, the official journal of the AGA Institute,
is the most prominent scientific journal in the specialty and is in the
top 1 percent of indexed medical journals internationally. The journal
publishes clinical and basic science studies of all aspects of the
digestive system, including the liver and pancreas, as well as
nutrition. The journal is abstracted and indexed in Biological
Abstracts, CABS, Chemical Abstracts, Current Contents, Excerpta Medica,
Index Medicus, Nutrition Abstracts and Science Citation Index. For more
information, visit www.gastrojournal.org.