- Design
- Prospective multicentre registry, 2004–2024
- Population
- 1,983 high-causality idiosyncratic DILI cases in the US
- Primary outcome
- Trends in causative agents, severity and outcomes
- Effect
- Antibiotics 41% overall and falling; supplements and anticancer drugs rising; oncology 6-month mortality 30%
The US Drug-Induced Liver Injury Network reviewed 1,983 high-causality cases enrolled from 2004 to 2024 and followed for six months. Median age was 52 and 59% were women.
Antibiotics remained the leading class (41%), but their share fell over time, including cases from isoniazid and nitrofurantoin. The share from herbal and dietary supplements and from anticancer drugs, including checkpoint inhibitors, rose. Severity at presentation fell over the period. Patients with chronic liver disease, those over 65 and oncology patients had higher mortality; oncology patients had 30% mortality at six months, mostly from non-liver causes.
The pattern in India is likely to differ — anti-TB drugs remain a dominant cause — but the rise of supplements is familiar, with widespread use of herbal and traditional products that patients often do not mention.
- Ask specifically about herbal, traditional and dietary supplements in any unexplained liver injury
- Consider checkpoint inhibitors and other anticancer drugs in oncology patients with liver injury
- Expect worse outcomes in DILI with pre-existing liver disease or age over 65
- Remember anti-TB drugs remain a leading cause in Indian practice
Why it matters
Patients rarely volunteer supplements as medicines, so the cause is missed unless asked.
Don't overread it
This is a US referral registry; the mix of causes differs in India, where anti-TB drugs remain prominent.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for gastroenterology & hepatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free