A Single‐Center Experience on Outcomes of Complementary and Alternative Medicine Use Among Patients With Cirrhosis

Philips, Cyriac Abby; Paramaguru, Rajaguru; Augustine, Philip; Rajesh, Sasidharan; Ahamed, Rizwan; George, Tom; Padsalgi, Guruprasad

doi:10.1002/hep4.1355

Cited by 19 publications

(23 citation statements)

References 25 publications

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“…In patients with CAM-DILI-related ACLF, 63% self-medicated based on social media sharing, 83% were male patients and overall 53% of patients died, with a median survival 194 days. Baseline overt hepatic encephalopathy and CLIF-C-organ failure score, total bilirubin, hyponatremia and leukocytosis, and grade of ACLF predicted 1-, 3-, 6- and 12-month mortality, respectively 27…”

Section: Prevalence Incidence Patterns Of Use and Outcomes: Currentmentioning

confidence: 95%

“…However, in the study on CAM-DILI-related ACLF, the most common CAM utilized by the cirrhosis patient population was that of Ayurveda (77%), of which, the majority were traditional indigenous herbal medicines prescribed by local healers for diabetes mellitus management. These included aloe vera, passionflower and guava leaf extracts, Phyllanthus niruri, Polygonum aviculare (wire weed), Malabar nut tree leaf extracts, Datura stramonium (devil’s weed) and Chlorophytum borivilianum (safed musli) 26,27…”

Section: Cams Associated With Liver Injurymentioning

confidence: 99%

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Complementary and Alternative Medicine-related Drug-induced Liver Injury in Asia

Philips¹,

Augustine²,

Rajesh³

et al. 2019

Journal of Clinical and Translational Hepatology

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The use of complementary and alternative medicines (CAMs) for treatment of acute and chronic diseases is on the rise world over, especially in Asian countries, and mostly in China and India. Drug-induced liver injury (DILI) due to CAM is increasingly reported in the literature from multiple centers all around the world and with large-number patient series published from the West, mostly based on nation-wide DILI networks and multicenter collaboration. Comprehensive DILI networks are lacking among major Asian countries with high incidence of CAM practices. Chinese medical societies dealing with drug toxicity, CAM practice and hepatobiliary disease have adopted an integrated approach to establishing identification, diagnosis and treatment of CAM-related DILI, representing a systematic approach that could be iterated by other countries for improving patient outcomes. In this exhaustive review, we provide published data on CAM-related DILI in Asia, with detail on incidences along with analysis of patient population and their clinical outcomes. Concise and clear discussion on commonly implicated CAM agents in major Asian countries and associated chemical and toxicology analyses as well as descriptions of liver biopsy findings are discussed with future directions.

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Section: Prevalence Incidence Patterns Of Use and Outcomes: Currentmentioning

confidence: 95%

Section: Cams Associated With Liver Injurymentioning

confidence: 99%

Complementary and Alternative Medicine-related Drug-induced Liver Injury in Asia

Philips¹,

Augustine²,

Rajesh³

et al. 2019

Journal of Clinical and Translational Hepatology

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“…The same authors showed that among cirrhosis patients consuming AHMs, 35.7% presented with severe DILI leading to acute on chronic liver failure (ACLF) with an overall mortality of 53%. In this series, the most common culprit leading to AHM-DILI were unlabelled polyherbal preparations followed by proprietary Ayurvedic drugs[ 6 ]. A recent multicentre study spearheaded by the Asian-Pacific Association for the Study of Liver (APASL) demonstrated that ACLF in Asia-Pacific countries was predominantly due to CAMs (in approximately 72% of patients) inclusive of Ayurvedic herbals and herbal and dietary supplements[ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Comprehensive review of hepatotoxicity associated with traditional Indian Ayurvedic herbs

Philips

Ahamed

Rajesh

et al. 2020

WJH

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With growing antipathy toward conventional prescription drugs due to the fear of adverse events, the general and patient populations have been increasingly using complementary and alternative medications (CAMs) for managing acute and chronic diseases. The general misconception is that natural herbal-based preparations are devoid of toxicity, and hence short- and long-term use remain justified among people as well as the CAM practitioners who prescribe these medicines. In this regard, Ayurvedic herbal medications have become one of the most utilized in the East, specifically the Indian sub-continent, with increasing use in the West. Recent well-performed observational studies have confirmed the hepatotoxic potential of Ayurvedic drugs. Toxicity stems from direct effects or from indirect effects through herbal metabolites, unknown herb-herb and herb-drug interactions, adulteration of Ayurvedic drugs with other prescription medicines, and contamination due to poor manufacturing practices. In this exhaustive review, we present details on their hepatotoxic potential, discuss the mechanisms, clinical presentation, liver histology and patient outcomes of certain commonly used Ayurvedic herbs which will serve as a knowledge bank for physicians caring for liver disease patients, to support early identification and treatment of those who present with CAM-induced liver injury.

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“…Drug-induced liver injury (DILI) and the toxicology of implicated Ayurvedic drugs among the healthy general population and patients with cirrhosis, leading to the syndrome of ACLF, have been demonstrated recently. 5,6 The false belief of a safer drug profile, cheaper treatment cost and easy approachability and availability of CAM-related health services, along with rampant advertisements regarding the liver disease, have been reported before; [11][12][13][14][15][16] outcomes associated with CAM use among patients with AH have not. In this novel study, we determined the clinical outcomes, liver histopathological patterns and toxicology of CAM-related DILI among patients with AH compared to a group of severe AH patients on standard of care.…”

Section: Introductionmentioning

confidence: 99%

“…The presence of necrosis in patients with CAM induced DILI, among both the general population and cirrhosis patients, has been previously documented to promote worse outcomes. 5,6 To the best of our abilities, we were able to retrieve a good proportion of the CAMs ingested by the patients at the start of their clinical symptoms. On analysis of these agents, we were able to clearly identify a multitude of liver toxic ingredients and undisclosed poisonous substances and multiple adulterants (mostly modern medicine related).…”

mentioning

confidence: 99%

Outcomes and Toxicology of Herbal Drugs in Alcoholic Hepatitis – A Single Center Experience from India

Philips¹,

Rajesh²,

George³

et al. 2019

Journal of Clinical and Translational Hepatology

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Background and Aims: We aimed to study clinical outcomes and liver biopsy features of alcoholic hepatitis (AH) patients on complementary and alternative medicines (CAMs) and to analyze the retrieved drugs for chemical and toxic components linked to drug-induced liver injury. Methods: We retrospectively assessed clinical, biochemical and liver biopsy features of AH patients on CAM with drug-induced liver injury (AH-CAM, n = 27) and compared them to a control group (classical AH, n = 29) on standard of care. Patients without liver biopsy evaluation and other causes for liver disease were excluded. Samples of the CAMs (n = 42) from patients were retrieved and assessed for chemical and toxins. Results: All were males, and significantly worse clinical presentation, biochemical severity, and liver disease scores were notable in patients with AH-CAM. Traditional Ayurvedic-polyherbal formulations were the most commonly used CAM. On liver histology, varying grades of severe-necrosis, severe hepatocellular, canalicular, cholangiolar cholestasis with predominant lymphocytic-portal-inflammation and varying grades of interface-hepatitis were noted in AH-CAM. Analysis of CAMs revealed presence of heavy metals up to 100,000 times above detectable range and adulterants, such as antibiotics, chemotherapy agents, nonsteroidal anti-inflammatory drugs, alcohols, antidepressants, anxiolytics, and recreational drugs. On follow up, a significantly higher number of patients with AH on CAM died at end of 1, 3-and-6-months compared to controls (37% vs. 83%, 29% vs. 62%, 18% vs. 52% respectively; p < 0.001). Conclusions: Patients with AH and CAM-related druginduced liver injury have extremely poor short-term survival in the absence of liver transplantation compared to those patients with AH on evidence-based management. Early transplant referral and educating on and curbing of CAM use in severe liver disease through strict monitoring of unregulated traditional health practices can help ease the burden of liver-related death.

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A Single‐Center Experience on Outcomes of Complementary and Alternative Medicine Use Among Patients With Cirrhosis

Cited by 19 publications

References 25 publications

Complementary and Alternative Medicine-related Drug-induced Liver Injury in Asia

Complementary and Alternative Medicine-related Drug-induced Liver Injury in Asia

Comprehensive review of hepatotoxicity associated with traditional Indian Ayurvedic herbs

Outcomes and Toxicology of Herbal Drugs in Alcoholic Hepatitis – A Single Center Experience from India

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