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Tools for causality assessment in drug-induced liver disease.

Publication ,  Journal Article
Tillmann, HL; Suzuki, A; Barnhart, HX; Serrano, J; Rockey, DC
Published in: Curr Opin Gastroenterol
May 2019

PURPOSE OF REVIEW: There are three liver-specific causality assessment tools currently available to guide clinical diagnosis of Drug-Induced Liver Injury (DILI): Roussel-Uclaf Causality Assessment Method (RUCAM), Digestive-Disease-Week Japan 2004 scale (DDW-J), and Clinical Diagnostic Scale (CDS). The purpose of this review is to assess these tools and discuss how to improve the causality assessment process as a whole. RECENT FINDINGS: Existing DILI-specific causality assessment tools are surprisingly similar and exhibit only minor differences in point allocation. But difference in threshold for likelihood of being DILI. We reviewed the literature on currently used causality assessment tools, identified areas for future improvement, and herein propose approaches for refinement. Opportunities to improve current models, as well as the assessment process, in general, include in particular provision of more precise clinical detail and to perhaps add new components to scoring systems. For example, the incorporation of drug-specific clinical signature patterns, accounting for a drug's inherent hepatotoxicity potential, and/or incorporation of other drug properties to scoring systems may allow enhancement. Further, more systemic exclusion of competing diagnoses is needed. Finally, causality assessment processes will likely benefit from a data-driven and computer-assisted approach. SUMMARY: Current tools used for DILI adjudication are imperfect. Avenues to improve these tools are described.

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Published In

Curr Opin Gastroenterol

DOI

EISSN

1531-7056

Publication Date

May 2019

Volume

35

Issue

3

Start / End Page

183 / 190

Location

United States

Related Subject Headings

  • Risk Factors
  • Reproducibility of Results
  • Humans
  • Gastroenterology & Hepatology
  • Chemical and Drug Induced Liver Injury
  • Causality
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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ICMJE
MLA
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Tillmann, H. L., Suzuki, A., Barnhart, H. X., Serrano, J., & Rockey, D. C. (2019). Tools for causality assessment in drug-induced liver disease. Curr Opin Gastroenterol, 35(3), 183–190. https://doi.org/10.1097/MOG.0000000000000526
Tillmann, Hans L., Ayako Suzuki, Huiman X. Barnhart, Jose Serrano, and Don C. Rockey. “Tools for causality assessment in drug-induced liver disease.Curr Opin Gastroenterol 35, no. 3 (May 2019): 183–90. https://doi.org/10.1097/MOG.0000000000000526.
Tillmann HL, Suzuki A, Barnhart HX, Serrano J, Rockey DC. Tools for causality assessment in drug-induced liver disease. Curr Opin Gastroenterol. 2019 May;35(3):183–90.
Tillmann, Hans L., et al. “Tools for causality assessment in drug-induced liver disease.Curr Opin Gastroenterol, vol. 35, no. 3, May 2019, pp. 183–90. Pubmed, doi:10.1097/MOG.0000000000000526.
Tillmann HL, Suzuki A, Barnhart HX, Serrano J, Rockey DC. Tools for causality assessment in drug-induced liver disease. Curr Opin Gastroenterol. 2019 May;35(3):183–190.

Published In

Curr Opin Gastroenterol

DOI

EISSN

1531-7056

Publication Date

May 2019

Volume

35

Issue

3

Start / End Page

183 / 190

Location

United States

Related Subject Headings

  • Risk Factors
  • Reproducibility of Results
  • Humans
  • Gastroenterology & Hepatology
  • Chemical and Drug Induced Liver Injury
  • Causality
  • 3202 Clinical sciences
  • 1103 Clinical Sciences