Drug-induced liver injuries in practice of primary care physician (review of clinical recommendations)

Abstract

Currently, due to the high availability of drugs and the growing volume of the pharmaceutical market, there is a clear trend towards an increase in the number of drug-induced liver injuries (DILI), which can be associated with the use of almost all classes of prescription or non-prescription drugs including herbal remedies, dietary supplements and biological food supplements, etc. Due to the high relevance of this problem, the article is devoted to the epidemiology and classification of DILI, the principles of management of patients with DILI, prognosis and prevention of DILI, taking into account European and Russian clinical recommendations for the management of patients with DILI – European Association for the Study of the Liver (EASL; 2019), Russian Gastroenterological Association (2019), Scientific Society of Gastroenterologists of Russia / Russian Scientific Medical Society of Therapists (NOGR / RNMOT) (2020). The criteria for the diagnosis of DILI are described in detail, a number of classifications of DILI are given (by severity, pathogenetic, clinical and laboratory, by phenotypes and clinical and morphological forms). Risk factors for DILI include age, gender, race, genetic factors, certain concomitant diseases and conditions, polypharmacy, drug-drug interactions, and drug characteristics (dose, duration of administration, lipophilicity, etc.). In the diagnosis of DILI, the central link is the assessment of cause-effect relationships between taking the inducer drug and the development of symptoms of liver damage, for this purpose it is recommended to use the CIOMS-RUCAM scale, and indications for liver biopsy are determined. The diagnosis of exclusion of DILI and its formulation require studies aimed at differentiation with acute viral hepatitis, autoimmune hepatitis, Wilson’s disease, Bad Chiari syndrome, primary biliary cholangitis, primary sclerosing cholangitis, cholelithiasis, and oncological diseases. Variants of the course of DILI with the selection of favorable and unfavorable prognostic signs are considered. The choice of hepatoprotective therapy has been discussed. The data on the possibilities of the drug Heptrong in the treatment of DILI are given. Particular attention is paid to preventive measures that impede the development of DILI.