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Title: Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions
Authors: Villanueva-Paz, Marina
Niu, Hao
Segovia-Zafra, Antonio
Medina-Caliz, Inmaculada
Sanabria-Cabrera, Judith
Lucena, M. Isabel
Andrade, Raúl J.
Alvarez-Alvarez, Ismael
metadata.dc.contributor.authoraffiliation: [Villanueva-Paz,M; Niu,H; Segovia-Zafra,A; Medina-Caliz,I; Sanabria-Cabrera,J; Lucena,MI; Andrade,RJ; Alvarez-Alvarez,I] Unidad de Gestión Clínica de Gastroenterología, Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga. [Niu,H; Segovia-Zafra,A; Sanabria-Cabrera,J; Lucena,MI; Andrade,RJ; Alvarez-Alvarez,I] Centro de Investigación Biomédica en Red en el Área Temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain. [Sanabria-Cabrera,J; Lucena,MI] Plataforma ISCIII de Ensayos Clinicos, UICEC-IBIMA, Malaga, Spain.
Keywords: Drug-induced liver injury;Severe cutaneous adverse reactions;Hypersensitivity;Gaps;Causality assessment;Diagnosis;Management;Clinical trial;Immune response;Enfermedad hepática inducida por sustancias y drogas;Hipersensibilidad;Relaciones intergeneracionales;Diagnóstico;Ensayo clínico;Inmunidad
metadata.dc.subject.mesh: Medical Subject Headings::Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 2-Ring::Purines::Allopurinol
Medical Subject Headings::Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 1-Ring::Pyridines::Nevirapine
Medical Subject Headings::Phenomena and Processes::Genetic Phenomena::Genetic Structures::Genome::Genome Components::Genes::Alleles
Medical Subject Headings::Anatomy::Tissues::Connective Tissue::Granulation Tissue::Cicatrix
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Glycoproteins::Membrane Glycoproteins::Histocompatibility Antigens Class I::HLA-B Antigens
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Membrane Proteins::Membrane Glycoproteins::Histocompatibility Antigens Class I::HLA-A Antigens
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis
Medical Subject Headings::Diseases::Skin and Connective Tissue Diseases::Skin Diseases
Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Amides::Sulfonamides
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents
Medical Subject Headings::Chemicals and Drugs::Pharmaceutical Preparations::Pharmaceutical Preparations, Dental
Issue Date: 15-Nov-2021
Publisher: MDPI
Citation: Villanueva-Paz M, Niu H, Segovia-Zafra A, Medina-Caliz I, Sanabria-Cabrera J, Lucena MI, et al. Critical Review of Gaps in the Diagnosis and Management of Drug-Induced Liver Injury Associated with Severe Cutaneous Adverse Reactions. J Clin Med. 2021 Nov 15;10(22):5317
Abstract: 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.
metadata.dc.identifier.doi: 10.3390/jcm10225317
ISSN: 2077-0383 (Online)
Appears in Collections:01- Artículos - IBIMA. Instituto de Investigación Biomédica de Málaga

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