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Role of Ursodeoxycholic Acid in Treating and Preventing Idiosyncratic Drug-Induced Liver Injury. A Systematic Review

Role of Ursodeoxycholic Acid in Treating and Preventing Idiosyncratic Drug-Induced Liver Injury. A Systematic Review


Title: Role of Ursodeoxycholic Acid in Treating and Preventing Idiosyncratic Drug-Induced Liver Injury. A Systematic Review
Author: Robles-Díaz, Mercedes
Nezic, Lana
Vujic-Aleksic, Vesna
Björnsson, Einar Stefán
Date: 2021-10-27
Language: English
Scope: 744488
Department: Office of Division of Clinical Services I
Faculty of Medicine
Series: Frontiers in Pharmacology; 12()
ISSN: 1663-9812
DOI: https://doi.org/10.3389/fphar.2021.744488
Subject: Lifrarsjúkdómar; Forvarnir; Meðferð; Lyfjaeitrun; drug-induced liver injury; hepatotoxicity; prevention; treatment; ursodeoxycholic acid; Pharmacology; Pharmacology (medical)
URI: https://hdl.handle.net/20.500.11815/3044

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Citation:

Robles-Díaz , M , Nezic , L , Vujic-Aleksic , V & Björnsson , E S 2021 , ' Role of Ursodeoxycholic Acid in Treating and Preventing Idiosyncratic Drug-Induced Liver Injury. A Systematic Review ' , Frontiers in Pharmacology , vol. 12 , 744488 , pp. 744488 . https://doi.org/10.3389/fphar.2021.744488

Abstract:

Introduction: Treatment is generally not available for drug-induced liver injury (DILI) patients except in some specific circumstances. The management of DILI is based on the withdrawal of the responsible drug and monitoring the patients and only a few patients need to be referred to a transplant center. Some studies on the role of ursodeoxycholic acid (UDCA) in DILI have been published. The aim of this study was to perform a systematic review of the role of UDCA in the treatment and prevention of DILI. Methods: A search was undertaken in PubMed, with the key words ursodeoxycholic acid, drug-induced liver injury and hepatotoxicity following the PRISMA guidelines. Results: A total of 33 publications were identified: 25 case reports and 8 case series. In 18 of the 25 cases reports (22 patients), authors reported improvement of liver injury associated with UDCA therapy whereas 7 case reports did not show clinical or biochemical improvement after UDCA treatment. There were 4 studies evaluating the role of UDCA in the treatment of DILI, three prospective (one being a clinical trial) and one retrospective studies. Three studies observed liver profile improvements associated with UDCA. In addition, four studies evaluated UDCA in the prevention of DILI: one pilot study, two randomized clinical trials (RCT) and one retrospective study. Three of these studies observed a lower percentage of patients with an increase in transaminases in the groups that used UDCA for DILI prevention. Conclusion: According to available data UDCA seems to have some benefits in the treatment and prevention of DILI. However, the design of the published studies does not allow a firm conclusion to be drawn on the efficacy of UDCA in DILI. A well designed RCT to evaluate the role of UDCA in DILI is needed.

Description:

The present study has been supported by grants of the Instituto de Salud Carlos III co-founded by Fondo Europeo de Desarrollo Regional–FEDER (contract number: PI 18-00901), the Consejería de Salud de la Junta de Andalucía (PI-0274/2016; Acción B de refuerzo investigador del SAS Expediente B-0002-2019; UMA18-FEDERJA-193) and by the Agencia Española del Medicamento. CIBERehd is funded by Instituto de Salud Carlos III. This article is based upon work from COST Action “CA17112–Prospective European Drug-Induced Liver Injury Network” supported by COST (European Cooperation in Science and Technology). www.cost.eu MR-D, LN, VV-A and EB are members of COST Action CA17112. Publisher Copyright: © Copyright © 2021 Robles-Díaz, Nezic, Vujic-Aleksic and Björnsson.

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