1
|
Pinazo-Bandera JM, Niu H, Alvarez-Alvarez I, Medina-Cáliz I, Del Campo-Herrera E, Ortega-Alonso A, Robles-Díaz M, Hernández N, Paraná R, Nunes V, Girala M, Bessone F, Lucena MI, Andrade RJ, García Cortés M. Rechallenge in idiosyncratic drug-induced liver injury: An analysis of cases in two large prospective registries according to existing definitions. Pharmacol Res 2024; 203:107183. [PMID: 38631619 DOI: 10.1016/j.phrs.2024.107183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Data on positive rechallenge in idiosyncratic drug-induced liver injury (DILI) are scarce. We aim to analyse the clinical presentation, outcome and drugs associated with positive rechallenge in two DILI registries. METHODS Cases from the Spanish and Latin American DILI registries were included. Demographics, clinical characteristics and outcome of cases with positive rechallenge according to CIOMS/RUCAM and current definitions were analysed. RESULTS Of 1418 patients with idiosyncratic DILI, 58 cases had positive rechallenge (4.1%). Patients with positive rechallenge had shorter duration of therapy (p=0.001) and latency (p=0.003). In patients with rechallenge, aspartate transaminase levels were increased (p=0.026) and showed a prolonged time to recovery (p=0.020), albeit no differences were seen in terms of fatal outcomes. The main drug implicated in rechallenge was amoxicillin-clavulanate (17%). The majority of re-exposure events were unintentional (71%). Using both existing definitions of positive rechallenge, there were four cases which exclusively fulfilled the current criteria and five which only meet the historical definition. All cases of positive rechallenge, irrespective of the pattern of damage, fulfilled the criteria of either alanine transaminase (ALT) ≥3 times the upper limit of normal (ULN) and/or alkaline phosphatase (ALP) ≥2 times ULN. CONCLUSIONS Episodes of rechallenge were characterised by shorter duration of therapy and latency, and longer time to resolution, but did not show an increased incidence of fatal outcome. Based on our findings, ALT ≥3 times ULN and/or ALP ≥2 times ULN, regardless of the pattern of damage, is proposed as a new definition of rechallenge in DILI.
Collapse
Affiliation(s)
- J M Pinazo-Bandera
- Service of Gastroenterology and Hepatology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédico en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - H Niu
- Service of Clinical Farmacology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain
| | - I Alvarez-Alvarez
- Service of Gastroenterology and Hepatology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain
| | - I Medina-Cáliz
- Service of Clinical Farmacology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain
| | - E Del Campo-Herrera
- Service of Gastroenterology and Hepatology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain
| | - A Ortega-Alonso
- Service of Gastroenterology and Hepatology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédico en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - M Robles-Díaz
- Service of Clinical Farmacology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédico en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | - R Paraná
- University Hospital Prof. Edgard Santos-UFBA, Salvador, Brasil
| | - V Nunes
- University Hospital Prof. Edgard Santos-UFBA, Salvador, Brasil
| | - M Girala
- Clínicas Hospital, Asunción, Paraguay
| | - F Bessone
- Centenario Hospital, Rosario National University, Rosario, Argentina
| | - M I Lucena
- Service of Clinical Farmacology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédico en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - R J Andrade
- Service of Gastroenterology and Hepatology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédico en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
| | - M García Cortés
- Service of Gastroenterology and Hepatology, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédico en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| |
Collapse
|