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Antimicrobials, herbal and dietary supplements common causes of idiosyncratic DILI

PHILADELPHIA — Antimicrobials and herbal and dietary supplements are the most common causes of idiosyncratic drug-induced liver injury, or DILI, according to data presented at the ACG Annual Scientific Meeting.

“Idiosyncratic DILI accounts for up to 12% of acute liver failure cases in the United States,” Naga P. Chalasani, MD, a professor of cellular and integrative physiology at the Indiana University School of Medicine in Bloomington, said during his plenary session presentation. “The aim of this particular presentation is to report the characteristics and selected subgroup analyses of the first 1,257 patients enrolled in the DILI prospective study.”

Naga P. Chalasani

Of those, 899 were included in the final analysis and followed for at least 6 months. These patients were deemed to have either definite DILI (n=235), highly likely to have DILI (n=466) or probable DILI (n=198). Seventeen percent of patients developed chronic DILI, and death or liver transplantation occurred in 10% of patients during follow-up.

The five most common classes of agents that were attributed to 86% of all DILI cases were: antimicrobials (n=408), herbal and dietary supplements (n=145), cardiovascular system agents (n=88), central nervous system agents (n=82) and antineoplastic agents (n=49). Nine of the top 10 individual agents were antimicrobials and were attributed to 36% of all the DILI cases.

Cholestatic DILI was prevalent in patients aged at least 65 years (n=149) compared with patients younger than 65 years (n=750). However, the mortality and liver transplantation rates were similar among both age groups.

Mortality rates for DILI caused by amoxicillin-clavulanate, minocycline and cefazolin were between 0% and 1%, whereas ciprofloxacin accounted for 19% of mortality from DILI.  

“DILI is certainly rare, but it carries significant morbidity and mortality,” Chalasani said. “Antimicrobials and herbal and dietary supplements are the big, two most common groups of agents to cause DILI in our experience.”

For more information:

Chalasani N. Abstract 31. Presented at: ACG Annual Scientific Meeting, Oct. 17-22, 2014; Philadelphia.

Disclosure: See the abstract for a full list of relevant financial disclosures.