DRESS cases included in the Spanish and Latin-American DILI registries: clinical phenotype and outcome

Medina‐Cáliz, Inmaculada; Almarza, M; Stephens, Camilla; Robles‐Díaz, Mercedes; Sanabria‐Cabrera, Judith; González-Jiménez, A.; Sanjuán-Jiménez, Rocío; Ortega‐Alonso, Aida; Cortés, Miren García; García‐Muñoz, B.; Quiros-Cano, M.; Martín‐Reyes, Flores; Cueto, A; Fernández, M; Ginès, Pere; Gomez, Mariana; Soriano, Gabriela; Prieto, M.; Conde, Ignacio Suárez; Bessone, Fernando; Hernández, Nora; Arrese, Marco; Cabello, M.R.; Lucena, M. Isabel; Andrade, R.J.

doi:10.1016/s0168-8278(18)31459-4

Cited by 3 publications

(10 citation statements)

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“…The all‐cause mortality rate of DILI with SJS/TEN in this study was 34.6%, which was similar to that in India (36.1%) 8 and USA (44.4%) 10 . None of the 3 patients with DILI combined with SJS/TEN in Spanish DILI Registry expired 5,9 . The all‐cause mortality rate of DILI with DRESS in our series was 13.5%, which was much better than 34.6% in SJS/TEN, but still worse than 10.5% in pure DILI cases.…”

Section: Discussionsupporting

confidence: 79%

“…In the present study, hepatocellular liver injury was the preponderant type in DILI with SJS/TEN group, where cholestatic liver injury was the major type in DILI with DRESS group, which was different from the previous reports. 5,9 The majority of patients in Spain and Latin-America were DILI with DRESS cases, of which the hepatocellular type was the dominant type of liver injury. 5,9 All the patients in Indian study were DILI with SJS/TEN, of which the mixed type was the main type.…”

Section: Ta B L E 3 Comparison Between Nonsurvivors and Survivors In 158 Patients With Dili And Scarmentioning

confidence: 99%

“…5,9 The majority of patients in Spain and Latin-America were DILI with DRESS cases, of which the hepatocellular type was the dominant type of liver injury. 5,9 All the patients in Indian study were DILI with SJS/TEN, of which the mixed type was the main type. 8 In a retrospective study from Taiwan, 13 cholestatic type was the dominant type in DILI with DRESS cases, which was consistent with ours.…”

Section: Ta B L E 3 Comparison Between Nonsurvivors and Survivors In 158 Patients With Dili And Scarmentioning

confidence: 99%

“…5 A few recent studies have shown that DILI concomitant with SCAR may have a poor outcome than those without skin reactions. [5][6][7][8][9][10] However, most of the previous reports had limited case number, or were retrospective studies with different definition of DILI, which rendered various clinical manifestations and outcomes. [10][11][12][13][14][15] In addition, the implicated drugs to DILI and SCAR were diverse in different countries.…”

Section: Introductionmentioning

confidence: 99%

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Drug‐induced liver injury associated with severe cutaneous adverse drug reactions: A nationwide study in Taiwan

Chang

et al. 2021

Liver International

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Background & Aims Severe cutaneous adverse drug reactions (SCARs) including Stevens‐Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP) are high‐mortality adverse drug reactions. The risk factors and prognosis of drug‐induced liver injury (DILI) concomitant with SCAR warrant clarification. We aimed to evaluate the characteristics and outcomes of DILI with SCAR. Methods We analysed the database of a 10‐year multi‐centre prospective study in Taiwan from 2011 to 2020. Results A total of 1415 patients with DILI were enrolled, including 81 cases combined with SJS/TEN, 74 with DRESS, 3 with AGEP and 1257 with pure DILI. Approximated 11.2% of patients had SCAR, of which allopurinol was the leading incriminated drug, followed by sulphonamides and carbamazepine. The SJS/TEN group had the highest mortality (34.6%). Jaundice, acute kidney injury and SJS/TEN were independent risk factors of mortality (odds ratio: 29.54, 4.43 and 4.86, respectively, P < .003). Chronic kidney disease with high‐dose allopurinol also contributed to high mortality (78.9%) in cases of allopurinol‐induced DILI with SCAR. The HLA‐B*5801 was associated with a high risk and mortality of allopurinol‐induced DILI with SCAR. Likewise, the HLA‐B*1502 was closely related to carbamazepine‐induced DILI with SCAR. Conclusions DILI patients combined with SCAR are common and have a high mortality in Taiwan. Allopurinol is the leading incriminated drug. Jaundice, acute kidney injury and SJS/TEN are risk factors of mortality. HLA‐B*5801, chronic kidney disease and high drug dosage also contribute to high mortality in allopurinol‐induced DILI with SCAR.

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Section: Discussionsupporting

confidence: 79%

Section: Ta B L E 3 Comparison Between Nonsurvivors and Survivors In 158 Patients With Dili And Scarmentioning

confidence: 99%

Section: Ta B L E 3 Comparison Between Nonsurvivors and Survivors In 158 Patients With Dili And Scarmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Drug‐induced liver injury associated with severe cutaneous adverse drug reactions: A nationwide study in Taiwan

Chang

et al. 2021

Liver International

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“…However, retrospective studies from Korea and Singapore identified allopurinol as the most frequent culprit drug for SJS/TEN associated with DILI [7,17]. Nevertheless, for DRESS syndrome, the responsible drugs and drug classes were the same in most studies: allopurinol, anti-infectives, aromatic anticonvulsants, and nonsteroidal anti-inflammatory drugs (NSAIDs) [6][7][8][9][10][12][13][14][17][18][19]. In the multinational Registry of Severe Cutaneous Adverse Reactions (RegiSCAR), which is the largest international SCARs registry, the most frequent culprit drugs implicated in DRESS were anticonvulsants (carbamazepine, phenytoin, lamotrigine), allopurinol, sulfonamides and antibiotics [20].…”

Section: Introductionmentioning

confidence: 99%

Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions

Paz

Niu

Segovia-Zafra

et al. 2021

JCM

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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.

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Drug-Induced liver Injury Associated with Severe Cutaneous Hypersensitivity Reactions: A Complex Entity in Need of a Multidisciplinary Approach

Sanabria‐Cabrera

Medina‐Cáliz

Stankevičiūtė

et al. 2019

CPD

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Idiosyncratic drug-induced liver injury (DILI) occasionally occurs in the setting of severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS). This strengthens the proposed immunologic mechanism associated with this adverse reaction. DRESS exhibits the most common association with DILI. SCARs have a wide spectrum of heterogeneous clinical presentations and severity, and genetic predisposition has been identified. In the context of SCARs, DILI present a different clinical picture, ranging from mild injury to acute liver failure. Elucidating the role of DILI in the clinical presentation and outcome of SCARs represents a challenge due to limited information from published studies and the lack of consensus on definitions. The cholestatic and mixed pattern of liver damage typically predominates in the case of DILI associated with SCARs, which is different from DILI without SCARs where hepatocellular is the most common injury pattern. Only a few drugs have been associated with both DILI and SCARs. Is this article, the criteria used for DILI recognition among SCARS have been revised and discussed, along with the drugs most commonly involved in these syndromes as well as the outcome, prognostic factors and the need for a multidisciplinary approach to improve the management of DILI in the context of SCARs.

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DRESS cases included in the Spanish and Latin-American DILI registries: clinical phenotype and outcome

Cited by 3 publications

References 0 publications

Drug‐induced liver injury associated with severe cutaneous adverse drug reactions: A nationwide study in Taiwan

Drug‐induced liver injury associated with severe cutaneous adverse drug reactions: A nationwide study in Taiwan

Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions

Drug-Induced liver Injury Associated with Severe Cutaneous Hypersensitivity Reactions: A Complex Entity in Need of a Multidisciplinary Approach

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