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Drug-induced liver injury: present and future

25 Sep 2012

Liver injury due to prescription and nonprescription medications is a growing medical, scientific, and public health
problem. Worldwide, the estimated annual incidence rate of drug-induced liver injury (DILI) is 13.9-24.0 per 100,000
inhabitants. DILI is one of the leading causes of acute liver failure in the US. In Korea, the annual extrapolated incidence
of cases hospitalized at university hospital is 12/100,000 persons/year. Most cases of DILI are the result of idiosyncratic
metabolic responses or unexpected reactions to medication. There is marked geographic variation in relevant agents;
antibiotics, anticonvulsants, and psychotropic drugs are the most common offending agents in the West, whereas in
Asia, ‘herbs’ and ‘health foods or dietary supplements’ are more common. Different medical circumstances also cause
discrepancy in definition and classification of DILI between West and Asia. In the concern of causality assessment,
the application of the Roussel Uclaf Causality Assessment Method (RUCAM) scale frequently undercounts the cases
caused by ‘herbs’ due to a lack of previous information and incompatible time criteria. Therefore, a more objective and
reproducible tool that could be used for the diagnosis of DILI caused by ‘herbs’ is needed in Asia. In addition, a reporting
system similar to the Drug-Induced Liver Injury Network (DILIN) in the US should be established as soon as possible in
Asia.

Click here to view the full article which appeared in Clinical and Molecular Hepatlogy