A chronic adverse reaction may occur in some instances of drug-induced liver injury, even despite drug cessation.
Dr Raúl Andrade and colleagues from Spain obtained records from a Spanish registry and evaluated cases of drug-induced liver injury with biochemical evidence of long-term damage.
Chronic outcome was defined as a persistent biochemical abnormality of hepatocellular pattern of damage.
The team assessed hepatocellular damage more than 3 months after drug withdrawal or more than 6 months after cholestatic/mixed damage.
|Cholestatic damage is more prone to become chronic|
Data on 28 patients with a chronic clinical evolution between 1995 and 2005 were retrieved.
The researchers noted that these patients accounted for 6% of total idiosyncratic drug-induced liver injury cases submitted to the registry.
The main drug classes were cardiovascular and central nervous system.
The team noted that these represented only 10% and 13%, respectively, of all drug-induced liver injury cases.
The researchers found that the most frequent causative drugs were amoxicillin-clavulanate, bentazepam, atorvastatin, and captopril.
Patients with cholestatic/mixed injury were more prone to chronicity than patients with hepatocellular injury.
In the case of chronic hepatocellular injury, the team observed that 3 patients progressed to cirrhosis and 2 to chronic hepatitis.
In the cholestatic/mixed group, liver biopsy indicated cirrhosis in 1 patient and ductal lesions in 3 patients.
Dr Andrade's team concludes, “Cholestatic or mixed type of damage is more prone to become chronic while, in the hepatocellular pattern, the severity is greater.”
“Cardiovascular and central nervous system drugs are the main groups leading to chronic liver damage.”