RT Generic
T1 Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions
A1 Villanueva-Paz, Marina
A1 Niu, Hao
A1 Segovia-Zafra, Antonio
A1 Medina-Caliz, Inmaculada
A1 Sanabria-Cabrera, Judith
A1 Lucena, M. Isabel
A1 Andrade, Raul J.
A1 Alvarez-Alvarez, Ismael
K1 drug-induced liver injury
K1 severe cutaneous adverse reactions
K1 hypersensitivity
K1 gaps
K1 causality assessment
K1 diagnosis
K1 management
K1 clinical trial
K1 immune response
K1 Toxic epidermal necrolysis
K1 Stevens-johnson syndrome
K1 Systemic symptoms dress
K1 Induced hypersensitivity reactions
K1 Lymphocyte-transformation test
K1 Causality assessment methods
K1 Clinical-features
K1 Idiosyncratic hepatotoxicity
K1 Intravenous immunoglobulin
K1 Immunomodulating therapies
AB Drug-induced liver injury (DILI) encompasses the unexpected damage that drugs can cause to the liver. DILI may develop in the context of an immunoallergic syndrome with cutaneous manifestations, which are sometimes severe (SCARs). Nevirapine, allopurinol, anti-epileptics, sulfonamides, and antibiotics are the most frequent culprit drugs for DILI associated with SCARs. Interestingly, alleles HLA-B*58:01 and HLA-A*31:01 are associated with both adverse reactions. However, there is no consensus about the criteria used for the characterization of liver injury in this context, and the different thresholds for DILI definition make it difficult to gain insight into this complex disorder. Moreover, current limitations when evaluating causality in patients with DILI associated with SCARs are related to the plethora of causality assessment methods and the lack of consensual complementary tools. Finally, the management of this condition encompasses the treatment of liver and skin injury. Although the use of immunomodulant agents is accepted for SCARs, their role in treating liver injury remains controversial. Further randomized clinical trials are needed to test their efficacy and safety to address this complex entity. Therefore, this review aims to identify the current gaps in the definition, diagnosis, prognosis, and management of DILI associated with SCARs, proposing different strategies to fill in these gaps.
PB Mdpi
YR 2021
FD 2021-11-01
LK https://hdl.handle.net/10668/26977
UL https://hdl.handle.net/10668/26977
LA en
DS RISalud
RD Apr 12, 2025