Drug-induced liver injury: An overview and update

Drug-induced liver injury (DILI) is a relatively rare but important adverse event for a variety of commonly used drugs, herbal and dietary supplements, illegal drugs and novel agents. The actual epidemiology of DILI is difficult to evaluate and varies between different countries. Many risk factors have been identified for DILI but the exact and detailed mechanisms of DILI still remain largely unknown. DILI has been typically classified as direct or idiosyncratic, but indirect injury has been recognized as the third type of DILI. It is difficult to predict and prevent DILI due to the lack of acute diagnosis tools. Many novel serum biomarkers have been identified for DILI and need further study in the clinic. For management, discontinuation of suspicious drugs is the first and important step. Effective drugs treatment is limited but novel drugs have been explored. Novel drugs, such as immune checkpoint inhibitors and monoclonal antibodies, have emerging as important causative agents of DILI. This paper reviewed the epidemiology, risk factors, pathogenesis, clinical presentation, causative agents, diagnosis and management of DILI.