An update on drug‐induced liver injury—What's new?

Drug-induced liver injury (DILI) is an important medical condition. Recently, development of novel causality assessment tools has improved the diagnostic accuracy of idiosyncratic DILI, particularly RECAM (Revised Electronic Version of Roussel Uclaf Causality Assessment [RUCAM]). RECAM was found to be better than RUCAM in difficult cases and increased the precision of the DILI diagnosis but needs further refinement. In recent years, there has been an increased incidence of DILI with drugs, such as oncological drugs and herbal and dietary supplements (HDSs). DILI is commonly associated with checkpoint-induced liver injury. Treatment with corticosteroids has been the standard of care in this type of liver injury, but its use is controversial and potentially harmful. With the help of liver biopsy, 60% of subjects can avoid corticosteroids. In recent years, a number of dietary supplements have been found to lead to DILI, such as turmeric, Garcinia cambogia, kratom and ashwagandha. HLA-B*35:01 has been identified as a risk factor for green tea extract-induced liver injury. International collaborative efforts have tried to find candidate biomarkers, but no biomarker has yet demonstrated superior performance to standard liver tests. FDA has recently approved the use of serum glutamate dehydrogenase (GLDH) as a biomarker to distinguish liver injury from muscle injury. Serum GLDH should be used alongside standard liver injury monitoring in patients without pre-existing liver disease. In the current review, recent findings in DILI are presented on diagnostic strategies, new agents such as checkpoint inhibitors and HDSs leading to DILI, biomarkers and new therapies.