Corticosteroid poses no excess mortality risk in drug-induced liver injury

Treatment with corticosteroid in patients with drug-induced liver injury (DILI) does not appear to contribute to increased risk of death but rather helps normalize liver enzymes, as shown in a study.

The study used data from the Spanish DILI Registry and Indiana University School of Medicine. A total of 724 patients (mean age 53 years, 50 percent women) with DILI were included, of whom 106 were treated with corticosteroids while 618 did not receive any treatment.

The pattern of liver injury was similar in the corticosteroid and untreated groups, and the most common was hepatocellular (64 percent and 59 percent, respectively; p=0.493). Significantly more patients in the corticosteroid than the untreated group had jaundice (85 percent vs 68 percent) and were hospitalized (80 percent vs 49 percent; p<0.001 for both).

Researchers conducted nearest neighbour propensity score matching analyses involving 80 pairs of propensity score-matched corticosteroid-treated patients and those who did not receive any treatment. Results showed no association between corticosteroid administration and an increased risk of developing acute liver failure (odds ratio, 0.65, 95 percent confidence interval [CI], 0.18–2.40; p=0.518).

On further analysis, which included 41 propensity score-matched pairs, patients in the corticosteroid group had a significantly higher normalization rate of liver enzymes compared with those in the untreated group (hazard ratio [HR], 1.84, 95 percent CI, 1.02–3.32; p=0.043). This benefit was especially pronounced among patients whose serious injury did not resolve within 30 days (HR, 2.79, 95 percent CI, 1.20–6.50; p=0.018).

The findings warrant prospective, well-designed clinical trials to further evaluate the role of corticosteroid therapy in patients with more serious hepatotoxicity.