Drug-induced liver injury associated with liraglutide use: a case-based review of detection, severity, causality assessment, and clinical outcomes

Abstract

Background and Aim: Drug-induced liver injury (DILI) remains the most important etiology of acute liver failure in the United States. It often presents a diagnostic conundrum due to the lack of a specific biomarker or diagnostic modality. Liraglutide, a glucagon-like peptide-1 agonist, has recently gained clinical importance for its anti-obesity and anti-diabetic effects. While a constellation of adverse events has been reported, the published data on its hepatotoxic potential remains limited. We hereby delineate a rare case of liraglutide-associated DILI. Furthermore, a systematic review of MEDLINE, Google Scholar, Scopus, and Cochrane databases was conducted on DILI following liraglutide therapy. Specific terminologies were used to identify relevant English-language articles. The latest search date was December 20, 2022. Our search identified a total of 4 case reports (level of clinical evidence: IV). We discuss the limited available data on detection, severity, causality assessment, and clinical outcomes in patients with liraglutide-induced DILI. Relevance for Patients: DILI rarely occurs in patients undergoing liraglutide therapy. Clinicians and hepatologists can play a key role by promptly recognizing and stopping the offending agent. Therefore, intensive pharmacovigilance is imperative for ensuring patient safety and clinical effectiveness. Patients on liraglutide may be considered for baseline testing and periodic liver function monitoring.

Idiosyncratic DILI and RUCAM under One Hat: The Global View

“…Focusing on new drugs causing iDILI, a selection of reports is listed using exclusively the updated RUCAM (Table 11) [60,94,95,. • Atezolizumab score 7, probable Tzadok, 2022 [111] • Durvalumab score 6 or 7, probable Swanson, 2022 [112] • Ceftriaxone score 6, probable Asif, 2023 [113] • Enoxaparin score 8, probable Eze, 2023 [114] • Favipiravir score 6, probable Yamazaki, 2021 [115] • Fluoroquinolones scores 6-8, probable; score ≥9, highly probable Yang, 2019 [116] • Girosivan score 8, probable Ma, 2023 [117] • Ibuprofen score 8, probable Deng, 2022 [118] • Iguratimod Score 9, highly probable Li, 2018 [119] • Ipragliflozin score 7, probable Niijima, 2017 [120] • Liraglutide score 8, probable Inayat, 2023 [121] • Metformin score 10, highly probable Mian, 2023 [122] • Methotrexate scores 6-8, probable; ≥9, highly probable Qin, 2022 [123] • Nevirapine scores 6-8, probable Giacomelli, 2018 [124] Table 11. Cont.…”