Medikamentös-toxische Hepatopathie – eine unterschätzte Gefahr

In westlichen industrialisierten Regionen sind Medikamente bei über der Hälfte der Patienten die Ursache für ein akutes Leberversagen. Medikamentöse toxische Hepatopathien (DILI: drug-induced Liver Injury) werden durch eine Vielzahl von klinischen Erscheinungsbildern geprägt und stellen daher eine erhebliche diagnostische Herausforderung dar. Dieser Beitrag zeigt, wie DILI diagnostiziert wird und welche Therapieoptionen bestehen.

Abstract

Drug-induced toxic hepatopathies and drug-induced liver injury, DILI, are characterized by a variety of clinical manifestations and therefore represent a significant diagnostic challenge. This article shows how DILI is diagnosed and what therapy options exist. Current special cases of DILI genesis are also discussed (DOACs, IBD drugs, tyrosine kinase inhibitors). These newer substances and corresponding hepatotoxic effects are not yet fully understood. The internationally recognized and online available RUCAM score (Roussel Uclaf Causality Assessment Method) helps to assess the probability of drug-related toxic liver damage.

Kernaussagen

• DILI bleibt eine herausfordernde Diagnose.

• Ein fälschlicherweise erhobener DILI-Verdacht kann schwerwiegende Auswirkungen für die Betroffenen und ihre medikamentöse Therapie haben.

• Die Identifizierung spezifischer Biomarker findet im Rahmen der DILI-Diagnostik zunehmend Beachtung.

• Es fehlen valide Tests zur Vorhersage von patienteninhärenten Risikofaktoren für bestimmte DILI-Arten und prädiktive Methoden in Bezug auf arzneimittelassoziierte Risiken.

• Der online verfügbare RUCAM-Score (Roussel Uclaf Causality Assessment Method) hilft bei der Beurteilung der Wahrscheinlichkeit medikamentös-toxischer Leberschäden.

Schlüsselwörter

DILI - hepatotoxisch - idiosynkratisch - DOAC - RUCOM

Keywords

hepatotoxicity - DOAC - DILI - RUCOM

Publication History

Article published online:
26 June 2023

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