Fernando Bessone1, Miren García-Cortés2, Inmaculada Medina-Caliz3, Nelia Hernandez4, Raymundo Parana5, Manuel Mendizabal6, Maria I Schinoni5, Ezequiel Ridruejo7, Vinicius Nunes5, Mirta Peralta8, Genario Santos6, Margarita Anders9, Daniela Chiodi4, Martin Tagle10, Pedro Montes11, Enrique Carrera12, Marco Arrese13, M Isabel Lizarzabal14, Ismael Alvarez-Alvarez15, Estefania Caballano-Infantes15, Hao Niu15, Jose Pinazo16, Maria R Cabello15, M Isabel Lucena17, Raúl J Andrade2. 1. Hospital Provincial del Centenario, Universidad Nacional de Rosario, Rosario, Argentina; Centro de Investigación Biomédica en Red: Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. 2. UGC de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red: Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. 3. Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red: Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. 4. Hospital de Clínicas, Montevideo, Uruguay. 5. Hospital Universitário Prof. Edgard Santos-UFBA, Salvador, Brazil. 6. Hospital Universitario Austral, Pilar Centro, Provincia de Buenos Aires, Argentina. 7. Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina. 8. Hospital de infecciosas F. J. Muñiz, CABA, Buenos Aires, Argentina. 9. Hospital Alemán, CABA, Buenos Aires, Argentina. 10. Clínica Anglo Americana, Lima, Perú. 11. Hospital Nacional Daniel Alcides Carrion, Callao, Perú. 12. Hospital de Especialidades Eugenio Espejo, Quito, Ecuador. 13. Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 14. Hospital Universitario de Maracaibo, Maracaibo, Venezuela. 15. Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain. 16. UGC de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain. 17. Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red: Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. Electronic address: lucena@uma.es.
Abstract
BACKGROUND: Herbal and dietary supplements (HDS) consumption, a growing cause of hepatotoxicity, is a common practice among Latin-American populations. OBJECTIVES: To evaluate clinical, laboratory features and outcome in HDS-hepatotoxicity included in the Latin America-Drug Induced Liver Injury (LATINDILI) Network. METHODS: A total of 29 adjudicated cases of HDS hepatotoxicity reported to the LATINDILI Network from October 2011 through December 2019 were compared with 322 DILI cases due to conventional drugs and 16 due to anabolic steroids as well as with other series of HDS-hepatotoxicity. RESULTS: From 367 DILI cases, 8% were attributed to HDS. An increasing trend in HDS-hepatotoxicity was noted over time (p = .04). Camellia sinensis, Herbalife® products, and Garcinia cambogia, mostly used for weight loss, were the most frequently adjudicated causative agents. Mean age was 45 years (66% female). Median time to onset was 31 days. Patients presented typically with hepatocellular injury (83%) and jaundice (66%). Five cases (17%) developed acute liver failure. Compared to conventional medications and anabolic steroids, HDS hepatotoxicity cases had the highest levels of aspartate and alanine transaminase (p = .008 and p = .021, respectively), had more re-exposure events to the culprit HDS (14% vs 3% vs 0%; p = .026), and had more severe and fatal/liver transplantation outcomes (21% vs 12% vs 13%; p = .005). Compared to other DILI cohorts, less HDS hepatotoxicity cases in Latin America were hospitalized (41%). CONCLUSIONS: HDS-hepatotoxicity in Latin-America affects mainly young women, manifests mostly with hepatocellular injury and is associated with higher frequency of accidental re-exposure. HDS hepatotoxicity is more serious with a higher chance of death/liver transplantation than DILI related to conventional drugs.
BACKGROUND: Herbal and dietary supplements (HDS) consumption, a growing cause of hepatotoxicity, is a common practice among Latin-American populations. OBJECTIVES: To evaluate clinical, laboratory features and outcome in HDS-hepatotoxicity included in the Latin America-Drug Induced Liver Injury (LATINDILI) Network. METHODS: A total of 29 adjudicated cases of HDS hepatotoxicity reported to the LATINDILI Network from October 2011 through December 2019 were compared with 322 DILI cases due to conventional drugs and 16 due to anabolic steroids as well as with other series of HDS-hepatotoxicity. RESULTS: From 367 DILI cases, 8% were attributed to HDS. An increasing trend in HDS-hepatotoxicity was noted over time (p = .04). Camellia sinensis, Herbalife® products, and Garcinia cambogia, mostly used for weight loss, were the most frequently adjudicated causative agents. Mean age was 45 years (66% female). Median time to onset was 31 days. Patients presented typically with hepatocellular injury (83%) and jaundice (66%). Five cases (17%) developed acute liver failure. Compared to conventional medications and anabolic steroids, HDS hepatotoxicity cases had the highest levels of aspartate and alanine transaminase (p = .008 and p = .021, respectively), had more re-exposure events to the culprit HDS (14% vs 3% vs 0%; p = .026), and had more severe and fatal/liver transplantation outcomes (21% vs 12% vs 13%; p = .005). Compared to other DILI cohorts, less HDS hepatotoxicity cases in Latin America were hospitalized (41%). CONCLUSIONS: HDS-hepatotoxicity in Latin-America affects mainly young women, manifests mostly with hepatocellular injury and is associated with higher frequency of accidental re-exposure. HDS hepatotoxicity is more serious with a higher chance of death/liver transplantation than DILI related to conventional drugs.
Authors: Raj Vuppalanchi; Herbert L Bonkovsky; Jawad Ahmad; Huiman Barnhart; Francisco Durazo; Robert J Fontana; Jiezhun Gu; Ikhlas Khan; David E Kleiner; Christopher Koh; Don C Rockey; Elizabeth J Phillips; Yi-Ju Li; Jose Serrano; Andrew Stolz; Hans L Tillmann; Leonard B Seeff; Jay H Hoofnagle; Victor J Navarro Journal: Clin Gastroenterol Hepatol Date: 2021-08-14 Impact factor: 13.576