This is Dr. James H. Lewis.
I'm a professor of medicine and the Director of Hepatology in the division of
Gastroenterology at Georgetown University Medical Center, in Washington DC.
The topic for today's discussion is drug-induced liver injury (DILI):
where we've been, and where we are headed.
In the first part of my talk
I'm going to be discussing the importance of drug-induced liver injury, its epidemiology,
and the specific causes of drug-induced liver injury,
along with the mechanisms by which drugs can injure the liver.
In the second part of the talk
we'll be discussing risk factors for drug-induced liver injury,
including many of the host -
as well as pharmacologic - risk factors, along with
the recent research into pharmaco-genomic discovery.
The third part of the talk will include the rising incidence
of herbal and dietary supplement-related hepatotoxicity, and
the current methods by which we attempt to
diagnose DILI and the strategies used to treat and prevent DILI.
The magnitude of DILI is immense.
While it's rare to be seen in the clinic,
DILI's impact on drug development and
clinical practice is out of proportion to its incidence.
More than 700 drugs, herbal agents,
and chemicals have been implicated in causing drug-induced liver injury,
and it's the leading cause of
acute liver failure in the United States and other countries,
especially when we include acetaminophen (or paracetamol) as a cause.
It's also the leading cause of the failure to grant new drug approvals,
and has been the reason for withdrawal of new drugs in development.
About 7,000 DILI citations were cited between the year 2000 and 2009,
or about 700 annually.
Since then in the past decade,
over 6,000 citations were seen up to 2014, and currently
more than 1,500 publications dealing with drug-induced liver injury and
other aspects of hepatotoxicity have appeared annually since 2014.
What is drug-induced liver injury (DILI)?