‘The efficacy of extracorporeal liver support with molecular adsorbent recirculating system in severe drug-induced liver injury’

Eapen, Jaishvi; Ayoola, Rotimi; Subramanian, Ram

doi:10.1093/omcr/omx077

Cited by 7 publications

(6 citation statements)

References 17 publications

(21 reference statements)

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“…'Standard medical therapy' or no therapeutic details were given for 24 patients. [9][10][11][12][13][14][15][16][17][18] Seventeen patients received antipruritic therapy, predominantly antihistamines and rifampicin, colestyramine, naltrexone and phenobarbital. Twelve patients received UDCA alone, 3 received corticosteroids alone (Abeles RDA) 19 20 and 12 received corticosteroids and UDCA (3 due to 'failure' of UDCA (Abeles RDA)), 19 21 6 patients received MARS 9 16 22 and 1 received plasmapheresis.…”

Section: Resultsmentioning

confidence: 99%

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Abeles

Foxton²,

Khan

et al. 2020

BMJ Open Gastroenterol

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BackgroundAnabolic androgenic steroids (AAS) usage is widespread and increasing. AAS drug-induced liver injury (DILI) is recognised but its clinical course and management is poorly described. We report 2 cases of AAS DILI with associated renal dysfunction, managed successfully with oral corticosteroids.MethodsA comprehensive review identified 50 further cases to characterise the clinical and biochemical course. Causality grading was calculated using the updated Roussel Uclaf Causality Assessment Method (RUCAM) score. Data are presented as median values.ResultsThe most common AAS taken was methyldrostanolone. Patients commonly present with jaundice and pruritus but may exhibit other constitutional symptoms. Patients presented 56 days after starting, and bilirubin peaked 28 days after stopping, AAS. Causality assessment was ‘unlikely’ in 1 (2%), ‘possible’ in 31 (60%) and ‘probable’ in 20 (38%). Peak values were: bilirubin 705 μmol/L, alanine transaminase 125 U/L, aspartate transaminase 71 U/L, alkaline phosphatase 262 U/L, gamma-glutamyl transferase 52 U/L, international normalised ratio 1.1. Liver biopsies showed ‘bland’ canalicular cholestasis. 43% of patients developed kidney injury (peak creatinine 225 μmol/L). Therapies included antipruritics, ursodeoxycholic acid and corticosteroids. No patients died or required liver transplantation.ConclusionsPhysicians are likely to encounter AAS DILI. Causality assessment using the updated RUCAM should be performed but defining indications and proving efficacy for therapies remains challenging.

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Section: Resultsmentioning

confidence: 99%

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Abeles

Foxton²,

Khan

et al. 2020

BMJ Open Gastroenterol

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“…The role of TPE and MARS should be to serve as a "buying time" procedure, replacing liver dysfunction for a short time and/or bridging the gap between liver dysfunction to transplantation. Up to date, opposite results were shown considering the improvement in morbidity and mortality in ALF related to drug toxicity treated with TPE and MARS (Wittebole and Hantson, 2011;Donati et al, 2014;Díaz et al, 2016;Larsen et al, 2016;Eapen et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Novel Therapies for the Treatment of Drug-Induced Liver Injury: A Systematic Review

et al. 2022

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Many drugs with different mechanisms of action and indications available on the market today are capable of inducing hepatotoxicity. Drug-induced liver injury (DILI) has been a treatment challenge nowadays as it was in the past. We searched Medline (via PubMed), CENTRAL, Science Citation Index Expanded, clinical trials registries and databases of DILI and hepatotoxicity up to 2021 for novel therapies for the management of adult patients with DILI based on the combination of three main search terms: 1) treatment, 2) novel, and 3) drug-induced liver injury. The mechanism of action of novel therapies, the potential of their benefit in clinical settings, and adverse drug reactions related to novel therapies were extracted. Cochrane Risk of bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment approach was involved in the assessment of the certainty of the evidence for primary outcomes of included studies. One thousand three hundred seventy-two articles were identified. Twenty-eight articles were included in the final analysis. Eight randomized controlled trials (RCTs) were detected and for six the available data were sufficient for analysis. In abstract form only we found six studies which were also anaylzed. Investigated agents included: bicyclol, calmangafodipir, cytisin amidophospate, fomepizole, livina-polyherbal preparation, magnesium isoglycyrrhizinate (MgIG), picroliv, plasma exchange, radix Paeoniae Rubra, and S-adenosylmethionine. The primary outcomes of included trials mainly included laboratory markers improvement. Based on the moderate-certainty evidence, more patients treated with MgIG experienced alanine aminotransferase (ALT) normalization compared to placebo. Low-certainty evidence suggests that bicyclol treatment leads to a reduction of ALT levels compared to phosphatidylcholine. For the remaining eight interventions, the certainty of the evidence for primary outcomes was assessed as very low and we are very uncertain in any estimate of effect. More effort should be involved to investigate the novel treatment of DILI. Well-designed RCTs with appropriate sample sizes, comparable groups and precise, not only surrogate outcomes are urgently welcome.

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“…Albumin dialysis has been reported to be effective in a few cases of cholestatic drug-induced liver injury [37,38,39]. With this form of dialysis, albumin-bound toxins (such as bilirubin and bile salts) can be removed from circulation, which might support hepatic regeneration after withdrawal of the toxic agent.…”

Section: Discussion and Short Literature Reviewmentioning

confidence: 99%

Liver Injury after Selective Androgen Receptor Modulator Intake: A Case Report and Review of the Literature

Mertens,

Bömmer,

Regier

et al. 2023

Z Gastroenterol

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Liver injury associated with selective androgen receptor modulators (SARMs) is an issue that has not been reported often. We report a case of a previously healthy 24-year-old male, who was referred to our hospital for severe jaundice with intense pruritus. He had previously taken the SARM Enobosarm (also known as Ostarine) for muscle-building purposes. Blood serum levels of total bilirubin exceeded 30 mg/dL with only a slight elevation of liver enzymes. Liver biopsy revealed isolated hepatocellular cholestasis (bland cholestasis) with limited inflammation or necrosis. Supportive treatment was begun in our hospital with molecular adsorbent recirculation system (MARS) albumin dialysis, as well as cholestyramine for pruritus relief. During therapy, bilirubin levels and symptoms regressed, and after five sessions of dialysis, the patient could be released from our clinic in a markedly improved clinical and laboratory condition. However, bilirubin parameters regressed slowly after this, reaching normal levels as late as six months after first intake of the compound. Exome-based genetic testing brought about no pathogenic variants for cholestatic liver disease in our patient. Nevertheless, three common heterozygous polymorphisms associated with an increased risk for intrahepatic cholestasis could be identified. Our case demonstrates that SARMs can cause severe liver injuries not prominently mentioned in safety data sheets. Therefore, these compounds constitute a potential danger to the user’s health. This holds especially true when taking SARMs without supervision by a medical professional, which should consist of a thorough monitoring of liver enzyme and bilirubin levels.

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‘The efficacy of extracorporeal liver support with molecular adsorbent recirculating system in severe drug-induced liver injury’

Cited by 7 publications

References 17 publications

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Androgenic anabolic steroid-induced liver injury: two case reports assessed for causality by the updated Roussel Uclaf Causality Assessment Method (RUCAM) score and a comprehensive review of the literature

Novel Therapies for the Treatment of Drug-Induced Liver Injury: A Systematic Review

Liver Injury after Selective Androgen Receptor Modulator Intake: A Case Report and Review of the Literature

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