O-28 DRUG-INDUCED LIVER INJURY IN LATINAMERICA: First ten years’ experience of the ongoing LATINDILI Network

Introduction

In 2011, the Latin-American DILI-Network (LATINDILIN) set up under the guidance of the Spanish DILI Registry a network of hepatologists to prospectively identify and characterize DILI patients.

Aim

To evaluate the drugs more frequently associated with DILI in LA, clinical phenotype and outcome.

Methods

Demographics, clinical and biochemical parameters of all cases included in the LATINDILI Network were analysed according to the type of liver injury (hepatocellular, Hep; cholestatic, Chol and mixed, Mix).

Results

404 DILI cases were included. Anti-infectives (31%), musculoskeletal system drugs (13%) and herbal products (9.2%) were the main causative therapeutic drug classes. Mean age was 49 years (female sex, 61%). Hep injury predominated (62%) whereas Chol and Mix patterns were 24% and 15% of cases, respectively. Chol patients (mean age 56y) were older than Hep and Mix cases (47 and 50, p<0.05). Jaundice was more prevalent in Chol and Mix injury than in Hep cases (65% vs 75% vs 58%, respectively, p=0.062), though no differences in hospitalization rates were observed (Hep 43%, Chol and Mix 46%, p=0.867). Of note, 12 cases, mostly Hep, had a positive rechallenge. Positive autoantibodies were more common in Hep cases (25% vs Chol 9.1% vs Mix 19%, p=0.010), with nitrofurantoin/herbal products as the most common causative agents. Hep cases showed a higher risk of severe/fatal injury (18% vs 6.0% and 1.8% in Chol and Mix cases, respectively, p<0.001). The new Hy's law performed as expected, with 14% of ALF/Tx cases. Hep cases more frequently died from liver-related death (3.5%) compared with Chol (1.1%) and Mix (0) cases.

Conclusions

In Latin-American DILI cases with Hep pattern predominated, showing a higher severity and most frequent inadvertent re-exposition. The LATINDILI Network is proving as an important tool for the characterization of DILI singularities in this world region, and improvement of Public Health.

Funding

AEMPS, FEDER (PI18/01804). COST Action CA-17112.