Drug-induced liver injury

The lack of substantial advances in pre-clinical testing for hepatotoxicity has meant that drug-induced liver injury (DILI) remains an important issue during both the drug development and post-marketing phases. Several drug-related, genetic and non-genetic host factors influence the risk of DILI in any individual. The demonstration of human leukocyte antigen genotype as a strong risk factor for the development of DILI from a range of drugs has highlighted the role of the adaptive immune system in its pathogenesis; there is accumulating evidence that drug metabolism genes also contribute to some forms of DILI. Early recognition and prompt withdrawal of the drug is essential in preventing serious hepatic failure and is the critical step in the management of adverse reactions. The diagnosis of DILI relies upon the index of suspicion, careful evaluation of a temporal relationship between the exposure to a particular drug and the specific clinical event, and exclusion of potential alternative diagnoses. The high negative predictive value of genetic tests can be used to rule out DILI caused by specific drugs and to correctly identify the agent underlying DILI in a person exposed to two concomitant medications.