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News

Incidence of drug-induced liver injury 

A study in the latest issue of Gastroenterology examines the incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland.

News image

Little is known about the incidence of drug-induced liver injury in the general population.

Dr Einar Björnsson and colleagues from Iceland investigated the incidence, and the quantitative risk of drug-induced liver injury in a population-based cohort.

The research team performed a prospective study and collected data from 96 individuals diagnosed with drug-induced liver injury in Iceland from 2010 through 2011.

Liver injury was defined based on levels of alanine aminotransferase that were more than 3-fold the upper limit of normal, and/or alkaline phosphatase levels more than 2-fold the upper limit of normal.

Patients with acetaminophen toxicity were excluded.

The research team analyzed the drug history and clinical outcomes.

Drug-induced liver injury was caused by a single prescription medication in 75% of cases
Gastroenterology

Causality was assessed using the Roussel Uclaf Causality Assessment Method.

The patients were registered in prescription databases for outpatients and inpatients.

The crude annual incidence rate of drug-induced liver injury was 19 cases per 100,000 inhabitants.

The doctors found that drug-induced liver injury was caused by a single prescription medication in 75% of cases, by dietary supplements in 16% of cases, and by multiple agents in 9% of cases.

The most commonly implicated drugs were amoxicillin-clavulanate, diclofenac, azathioprine, infliximab, and nitrofurantoin.

The median duration of therapy was 20 days.

The team observed that 26 patients had jaundice, and 22 patients were hospitalized for a median of 5 days.

The researchers noted that overall 35,252 patients received amoxicillin-clavulanate as outpatients, and drug-induced liver injury occurred in 1 of 2350.

Drug-induced liver injury also occurred in 1 of 9480 patients taking diclofenac, 1 of 133 patients taking azathioprine, 1 of 148 patients taking infliximab, and 1 of 1369 patients taking nitrofurantoin.

Dr Björnsson's team commented, "In a population-based study in Iceland, the incidence of drug-induced liver injury was the highest reported to date."

"Amoxicillin-clavulanate was the most commonly implicated agent."

"The highest risk of hepatotoxicity was associated with azathioprine and infliximab, but the actual number of cases attributed to these agents was small."

Gastroenterol 2013: 144(7) :1419-1425
04 July 2013

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