Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network

Victor J. Navarro, Huiman Barnhart, Herbert L. Bonkovsky, Timothy Davern, Robert J. Fontana, Lafaine Grant, K. Rajender Reddy, Leonard B. Seeff, Jose Serrano, Averell H. Sherker, Andrew Stolz, Jayant Talwalkar, Maricruz Vega, Raj Vuppalanchi

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

The Drug-Induced Liver Injury Network (DILIN) studies hepatotoxicity caused by conventional medications as well as herbals and dietary supplements (HDS). To characterize hepatotoxicity and its outcomes from HDS versus medications, patients with hepatotoxicity attributed to medications or HDS were enrolled prospectively between 2004 and 2013. The study took place among eight U.S. referral centers that are part of the DILIN. Consecutive patients with liver injury referred to a DILIN center were eligible. The final sample comprised 130 (15.5%) of all subjects enrolled (839) who were judged to have experienced liver injury caused by HDS. Hepatotoxicity caused by HDS was evaluated by expert opinion. Demographic and clinical characteristics and outcome assessments, including death and liver transplantation (LT), were ascertained. Cases were stratified and compared according to the type of agent implicated in liver injury; 45 had injury caused by bodybuilding HDS, 85 by nonbodybuilding HDS, and 709 by medications. Liver injury caused by HDS increased from 7% to 20% (P<0.001) during the study period. Bodybuilding HDS caused prolonged jaundice (median, 91 days) in young men, but did not result in any fatalities or LT. The remaining HDS cases presented as hepatocellular injury, predominantly in middle-aged women, and, more frequently, led to death or transplantation, compared to injury from medications (13% vs. 3%; P<0.05). Conclusions: The proportion of liver injury cases attributed to HDS in DILIN has increased significantly. Liver injury from nonbodybuilding HDS is more severe than from bodybuilding HDS or medications, as evidenced by differences in unfavorable outcomes (death and transplantation).

Original languageEnglish (US)
Pages (from-to)1399-1408
Number of pages10
JournalHepatology
Volume60
Issue number4
DOIs
StatePublished - Oct 1 2014

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Chemical and Drug Induced Liver Injury
Dietary Supplements
Liver
Wounds and Injuries
Liver Transplantation
Transplantation
Expert Testimony
Jaundice

ASJC Scopus subject areas

  • Hepatology

Cite this

Navarro, V. J., Barnhart, H., Bonkovsky, H. L., Davern, T., Fontana, R. J., Grant, L., ... Vuppalanchi, R. (2014). Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. Hepatology, 60(4), 1399-1408. https://doi.org/10.1002/hep.27317

Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. / Navarro, Victor J.; Barnhart, Huiman; Bonkovsky, Herbert L.; Davern, Timothy; Fontana, Robert J.; Grant, Lafaine; Reddy, K. Rajender; Seeff, Leonard B.; Serrano, Jose; Sherker, Averell H.; Stolz, Andrew; Talwalkar, Jayant; Vega, Maricruz; Vuppalanchi, Raj.

In: Hepatology, Vol. 60, No. 4, 01.10.2014, p. 1399-1408.

Research output: Contribution to journalArticle

Navarro, VJ, Barnhart, H, Bonkovsky, HL, Davern, T, Fontana, RJ, Grant, L, Reddy, KR, Seeff, LB, Serrano, J, Sherker, AH, Stolz, A, Talwalkar, J, Vega, M & Vuppalanchi, R 2014, 'Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network', Hepatology, vol. 60, no. 4, pp. 1399-1408. https://doi.org/10.1002/hep.27317
Navarro VJ, Barnhart H, Bonkovsky HL, Davern T, Fontana RJ, Grant L et al. Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. Hepatology. 2014 Oct 1;60(4):1399-1408. https://doi.org/10.1002/hep.27317
Navarro, Victor J. ; Barnhart, Huiman ; Bonkovsky, Herbert L. ; Davern, Timothy ; Fontana, Robert J. ; Grant, Lafaine ; Reddy, K. Rajender ; Seeff, Leonard B. ; Serrano, Jose ; Sherker, Averell H. ; Stolz, Andrew ; Talwalkar, Jayant ; Vega, Maricruz ; Vuppalanchi, Raj. / Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. In: Hepatology. 2014 ; Vol. 60, No. 4. pp. 1399-1408.
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abstract = "The Drug-Induced Liver Injury Network (DILIN) studies hepatotoxicity caused by conventional medications as well as herbals and dietary supplements (HDS). To characterize hepatotoxicity and its outcomes from HDS versus medications, patients with hepatotoxicity attributed to medications or HDS were enrolled prospectively between 2004 and 2013. The study took place among eight U.S. referral centers that are part of the DILIN. Consecutive patients with liver injury referred to a DILIN center were eligible. The final sample comprised 130 (15.5{\%}) of all subjects enrolled (839) who were judged to have experienced liver injury caused by HDS. Hepatotoxicity caused by HDS was evaluated by expert opinion. Demographic and clinical characteristics and outcome assessments, including death and liver transplantation (LT), were ascertained. Cases were stratified and compared according to the type of agent implicated in liver injury; 45 had injury caused by bodybuilding HDS, 85 by nonbodybuilding HDS, and 709 by medications. Liver injury caused by HDS increased from 7{\%} to 20{\%} (P<0.001) during the study period. Bodybuilding HDS caused prolonged jaundice (median, 91 days) in young men, but did not result in any fatalities or LT. The remaining HDS cases presented as hepatocellular injury, predominantly in middle-aged women, and, more frequently, led to death or transplantation, compared to injury from medications (13{\%} vs. 3{\%}; P<0.05). Conclusions: The proportion of liver injury cases attributed to HDS in DILIN has increased significantly. Liver injury from nonbodybuilding HDS is more severe than from bodybuilding HDS or medications, as evidenced by differences in unfavorable outcomes (death and transplantation).",
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AU - Grant, Lafaine

AU - Reddy, K. Rajender

AU - Seeff, Leonard B.

AU - Serrano, Jose

AU - Sherker, Averell H.

AU - Stolz, Andrew

AU - Talwalkar, Jayant

AU - Vega, Maricruz

AU - Vuppalanchi, Raj

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