Drug-Induced Injury of Liver, Heart, Kidney, and Skin: Employing Recent Advances to Improve Patient Safety and Speed Up the Pipeline

A great unknown challenge is how to identify the patient who is especially susceptible to drug-induced injury, or who may not be able to adapt to the drug after an initial mild injury and thenceforth be able to tolerate the drug, before giving the drug, or in time to stop it before irreversible damage occurs. Serious DILI is usually rare, but we have no biomarker, genetic test, or other way to know who will get it in advance. We rely on observation of the patient's response to the new (for them) drug . Whether early symptoms, such as nausea, fatigue, right upper abdominal discomfort, or some other symptom may come first, or whether slight elevations of serum transaminase activity(or gammaglutamyl transpeptidase, or other) activity comes first, we don't yet know. For now, either symptoms or serum enzyme elevations should be reported very promptly and rechecked within a few days to find out whether they are worsening or improving, and what can be learned by additional tests, questions, or other ways to diagnose the most likely or probable cause of the abnormalities. In this session, we shall explore the question of whether underlying liver diseases of various types (fatty liver-steatohepatitis, alcoholic liver disease, or viral hepatitis C, B or other) can be distinguished from drug-induced injury, i.e., acute-on-chronic injury, and if the diseases may either enhance or diminish drug-effects. These difficult distinctions will be discussed by master clinicians whose work it is to make such diagnoses in practice, or in evaluation of new drugs.