Indirect drug-induced liver injury:New types and new challenges
Indirect drug-induced liver injury is a novel type of drug-induced liver injury(DILI),which is characterized by liver injury caused by the pharmacological effects of a drug,rather than the inherent hepatotoxicity or immunogenicity properties.There are three common types of indirect DILI in the clinic,namely,immune-mediated liver injury caused by checkpoint inhibitors,drug-induced hepatitis virus reactivation,and drug-induced or aggravated fatty liver disease by affecting hepatocyte metabolism.Due to insufficient clinical understanding by clinicians,indirect DILI is probably underdiagnosed and undertreated.With the rapid development and application of immune checkpoint inhibitors in recent years,indirect DILI has been a rapid increase,which poses a significant challenge for clinical diagnosis and treatment.Therefore,we conducted a review of the clinical characteristics,pathogenesis,diagnosis,and treatment strategies of indirect DILI,which has important clinical implications.
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