Current and future directions in the treatment and prevention of drug-induced liver injury: a systematic review

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#acetylcysteine #adrenal-cortex-hormones #antidotes #antioxidants #chelating-agents

Current and future directions in the treatment and prevention of drug-induced liver injury: a systematic review

Stine et al., 2016 | Expert Rev Gastroenterol Hepatol | Systematic Review

Citation

Stine Jonathan G, Lewis James H. Current and future directions in the treatment and prevention of drug-induced liver injury: a systematic review. Expert Rev Gastroenterol Hepatol. 2016;10(4):517-36. doi:10.1586/17474124.2016.1127756

Abstract

While the pace of discovery of new agents, mechanisms and risk factors involved in drug-induced liver injury (DILI) remains brisk, advances in the treatment of acute DILI seems slow by comparison. In general, the key to treating suspected DILI is to stop using the drug prior to developing irreversible liver failure. However, predicting when to stop is an inexact science, and commonly used ALT monitoring is an ineffective strategy outside of clinical trials. The only specific antidote for acute DILI remains N-acetylcysteine (NAC) for acetaminophen poisoning, although NAC is proving to be beneficial in some cases of non-acetaminophen DILI in adults. Corticosteroids can be effective for DILI associated with autoimmune or systemic hypersensitivity features. Ursodeoxycholic acid, silymarin and glycyrrhizin have been used to treat DILI for decades, but success remains anecdotal. Bile acid washout regimens using cholestyramine appear to be more evidenced based, in particular for leflunomide toxicity. For drug-induced acute liver failure, the use of liver support systems is still investigational in the United States and emergency liver transplant remains limited by its availability. Primary prevention appears to be the key to avoiding DILI and the need for acute treatment. Pharmacogenomics, including human leukocyte antigen genotyping and the discovery of specific DILI biomarkers offers significant promise for the future. This article describes and summarizes the numerous and diverse treatment and prevention modalities that are currently available to manage DILI.

Key Findings

This article describes and summarizes the numerous and diverse treatment and prevention modalities that are currently available to manage DILI.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Acetylcysteine
  • Adrenal Cortex Hormones
  • Antidotes
  • Antioxidants
  • Chelating Agents
  • Chemical and Drug Induced Liver Injury
  • Cholagogues and Choleretics
  • Genetic Predisposition to Disease
  • Humans
  • Liver Transplantation
  • Liver, Artificial
  • Patient Selection
  • Pharmacogenomic Testing
  • Phenotype
  • Precision Medicine
  • Risk Factors
  • Therapeutic Irrigation
  • Treatment Outcome

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Research Support, N.I.H., Extramural, Systematic Review
  • Vertical: milk-thistle

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09