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Herbal and Dietary Supplement-Induced Liver Injuries in the Spanish DILI Registry

2018; Elsevier BV; Volume: 16; Issue: 9 Linguagem: Inglês

10.1016/j.cgh.2017.12.051

1542-7714

Inmaculada Medina‐Cáliz, Miren García‐Cortés, A. González-Jiménez, María R. Cabello, Mercedes Robles‐Díaz, Judith Sanabria‐Cabrera, Rocío Sanjuán‐Jiménez, Aida Ortega‐Alonso, B. García‐Muñoz, Inmaculada Moreno, Miguel Jiménez‐Pérez, M. Carmen Fernández, Pere Ginés, M. Prieto, Isabel Conde, Hacibe Hallal, Germán Soriano, Eva Román, Agustín Castiella, Encarnación Blanco‐Reina, María Riaza Montes, Marta Quiros-Cano, Flores Martín‐Reyes, M. Isabel Lucena, Raúl J. Andrade, RJ Andrade, Mi Lucena, Camilla Stephens, Miren García‐Cortés, Mercedes Robles‐Díaz, Inmaculada Medina‐Cáliz, J. Sanabria, B. García‐Muñoz, R. Alcántara, Inmaculada Moreno, A. González-Jiménez, Aida Ortega‐Alonso, Rocío Sanjuán‐Jiménez, Ma Fuensanta Pérez Quirós, Flores Martín‐Reyes, Alyssa M. Papineau, Miguel Jiménez‐Pérez, Rocío González‐Grande, MC Fernández, Gloria Isabel Carvajal Peláez, Marta Casado, Manuel Gónzalez-Sánchez, Manuel Romero‐Gómez, R. Calle-Sanz, Raquel Millan‐Domínguez, Blanca Fombuena, R. Gallego, Liliana Rojas, Ángela Rojas, Javier Ampuero, JA del Campo, Antonio Gil‐Gómez, Eduardo Vilar, Agustín Castiella, EM Zapata, Leire Zubiaurre‐Elorza, JM Navarro, IM Méndez-Sánchez, A Chaves, Germán Soriano, Carlos Guarner, EM Román, Hacibe Hallal, Ester García-Oltra, JC Titos-Arcos, Antonio Pérez‐Martínez, C Sánchez-Cobarro, JM Egea-Caparrós, Juan Arenas, MI Gomez-Osua, Anel Gómez‐García, F.J. Esandi, Sonia Blanco, Pedro Martínez-Odriozola, Pedro Otazua, Javier Salmerón, A. Gómez Gila, R. Quiles, JM González, Sandra Lorenzo, M. Prieto, Isabel Conde, Amiel, Marina Berenguer, María García‐Eliz, J Primo, J.R. Molés, Ana Garayoa, Miguel F. Carrascosa, Eva Dominguez, Eva Montané, Ana Lucía Arellano, AM Barriocanal, Yolanda Sanz, R Morillas, María Sala, Helena Masnou, M. Llobet Farré, Miguel Bruguera, Pere Ginés, Sabela Lens, J C García, Ana Aldea‐Perona, Manuel Hernández‐Guerra, M Moreno-San Fiel, C Boada-Fernández del Campo, María Teresa Tejedor, R González-Ferrer, Carmen Muñoz Fernández, María del Pilar Fernández-Gil, JL Montero, Manuel de la Mata, J Fuentes-Olmo, Eva Fernández Bonilla, Javier González‐Gallego, Francisco Jorquera, J. de Manuel Moreno, P. Martínez-Rodenas, Marı́a J. Garrido, Paloma Rendón, Mercedes Vergara, Josué Delgado, Javier García‐Samaniego, Antonio Madejón, JL Cabriada, Javier Crespo, Álvaro Giráldez Gallego, M. Cuaresma, Rachel Ruiz,

Nephrotoxicity and Medicinal Plants

Background & AimsThere 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.MethodsWe 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.ResultsHerbal 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.ConclusionIn 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. 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. 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. 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. 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.