Herbal and Dietary Supplement-Induced Liver Injuries in the Spanish DILI Registry
Por:
Medina-Caliz, I, Garcia-Cortes, M, Gonzalez-Jimenez, A, Cabello, MR, Robles-Diaz, M, Sanabria-Cabrera, J, Sanjuan-Jimenez, R, Ortega-Alonso, A, Garcia-Munoz, B, Moreno, I, Jimenez-Perez, M, Fernandez, MC, Gines, P, Prieto, M, Conde, I, Hallal, H, Soriano, G, Roman, E, Castiella, A, Blanco-Reina, E, Montes, MR, Quiros-Cano, M, Martin-Reyes, F, Lucena, MI, Andrade, RJ
Publicada:
1 sep 2018
Resumen:
BACKGROUND & AIMS: There have been increasing reports of liver injury associated with use of herbal and dietary supplements, likely due to easy access to these products and beliefs among consumers that they are safer or more effective than conventional medications. We aimed to evaluate clinical features and outcomes of patients with herbal and dietary supplement-induced liver injuries included in the Spanish DILI Registry.
METHODS: We collected and analyzed data on demographic and clinical features, along with biochemical parameters, of 32 patients with herbal and dietary supplement-associated liver injury reported to the Spanish DILI registry from 1994 through 2016. We used analysis of variance to compare these data with those from cases of liver injury induced by conventional drugs or anabolic androgenic steroid-containing products.
RESULTS: Herbal and dietary supplements were responsible for 4% (32 cases) of the 856 DILI cases in the registry; 20 cases of DILI (2%) were caused by anabolic androgenic steroids. Patients with herbal and dietary supplement-induced liver injury were a mean age of 48 years and 63% were female; they presented a mean level of alanine aminotransferase 37-fold the upper limit of normal, 28% had hypersensitivity features, and 78% had jaundice. Herbal and dietary supplement-induced liver injury progressed to acute liver failure in 6% of patients, compared with none of the cases of anabolic androgenic steroid-induced injury and 4% of cases of conventional drugs. Liver injury after repeat exposure to the same product that caused the first DILI episode occurred in 9% of patients with herbal and dietary supplement-induced liver injury vs none of the patients with anabolic androgenic steroid-induced injury and 6% of patients with liver injury from conventional drugs.
CONCLUSION: In an analysis of cases of herbal and dietary supplement-induced liver injury in Spain, we found cases to be more frequent among young women than older patients or men, and to associate with hepatocellular injury and high levels of transaminases. Herbal and dietary supplement-induced liver injury is more severe than other types of DILI and re-exposure is more likely. Increasing awareness of the hepatoxic effects of herbal and dietary supplements could help physicians make earlier diagnoses and reduce the risk of serious liver damage.
Filiaciones:
Medina-Caliz, I:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Garcia-Cortes, M:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Gonzalez-Jimenez, A:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Cabello, MR:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Robles-Diaz, M:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Sanabria-Cabrera, J:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Hosp Univ Virgen de la Victoria, UICEC Inst Invest Biomed Malaga, Serv Farmacol Clin, Plataforma SCReN Spanish Clin Res Network, Malaga, Spain
Sanjuan-Jimenez, R:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Hosp Univ Virgen de la Victoria, UICEC Inst Invest Biomed Malaga, Serv Farmacol Clin, Plataforma SCReN Spanish Clin Res Network, Malaga, Spain
Ortega-Alonso, A:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Garcia-Munoz, B:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Moreno, I:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Jimenez-Perez, M:
Hosp Univ Reg Malaga, Inst Invest Biomed Malaga IBIMA, Unidad Gest Clin Aparato Digest, Malaga, Spain
Fernandez, MC:
Hosp Torrecardenas, Serv Farm, Almeria, Spain
Gines, P:
Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi Sunyer, Liver Unit,CIBERehd, Barcelona, Spain
Prieto, M:
Hosp La Fe, CIBERehd, IISLaFe, Unidad Gest Clin Enfermedades Digest, Valencia, Spain
Conde, I:
Hosp La Fe, CIBERehd, IISLaFe, Unidad Gest Clin Enfermedades Digest, Valencia, Spain
Hallal, H:
Hosp Morales Meseguer, Serv Aparato Digest, Murcia, Spain
Soriano, G:
Hosp Santa Creu & Sant Pau, Serv Aparato Digest, CIBERehd, Barcelona, Spain
Roman, E:
Hosp Santa Creu & Sant Pau, Serv Aparato Digest, CIBERehd, Barcelona, Spain
Castiella, A:
Hosp Mendaro, Serv Aparato Digest, Gipuzkoa, Spain
Blanco-Reina, E:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Montes, MR:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Quiros-Cano, M:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Martin-Reyes, F:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Lucena, MI:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
Hosp Univ Virgen de la Victoria, UICEC Inst Invest Biomed Malaga, Serv Farmacol Clin, Plataforma SCReN Spanish Clin Res Network, Malaga, Spain
Andrade, RJ:
Univ Malaga, Hosp Univ Virgen de la Victoria, Inst Invest Biomed Malaga,CIBERehd, Serv Farmacol Clin,Unidad Gest Clin Aparato Diges, Malaga, Spain
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