Therapeutic Management of Idiosyncratic Drug-Induced Liver Injury and Acetaminophen Hepatotoxicity in the Paediatric Population: A Systematic Review

Niu, Hao; Atallah, Edmond; Alvarez-Alvarez, Ismael; Medina-Caliz, Inmaculada; Aithal, Guruprasad P.; Arikan, Cigdem; Andrade, Raul J.; Lucena, M. Isabel

Abstract

Introduction
Drug-induced liver injury (DILI) is a rare but serious adverse event that can progress to acute liver failure (ALF). The evidence for treatment of DILI in children is scarce.

Objective
We aimed to comprehensively review the available literature on the therapies for both acetaminophen overdose (APAP) and idiosyncratic DILI in the paediatric population.

Methods
We included original articles conducted in a paediatric population (< 18 years) in which a therapeutic intervention was described to manage APAP or idiosyncratic DILI. Findings were summarized based on age groups (preterm newborn neonates, term and post-term neonates, infants, children and adolescents).

Results
Overall, 25 publications (fifteen case reports, six case series and four retrospective cohort studies) were included, including a total of 140 paediatric DILI cases, from preterm newborn neonates to adolescents. N-acetylcysteine was used to treat 19 APAP cases. N-acetylcysteine (n = 14), ursodeoxycholic acid (n = 3), corticosteroids (n = 31), carnitine (n = 16) and the combination of glycyrrhizin, reduced glutathione, polyene phosphatidylcholine and S-adenosylmethionine (n = 31) were the therapeutic options for treating idiosyncratic DILI. The molecular adsorbent recirculating system was used in the management of either APAP (n = 4) or idiosyncratic DILI (n = 2), while 20 paediatric ALF cases received continuous renal replacement therapy.

Conclusions
This systematic review identified DILI in the paediatric population who have received specific treatment. These interventions appear to be mainly extrapolated from low-quality evidence from the adult population. Thus, there is a need for high-quality studies to test the efficacy of known and novel therapies to treat DILI specifically addressed to the paediatric population.

PROSPERO registration number CRD42021214702.

Citation

Niu, H., Atallah, E., Alvarez-Alvarez, I., Medina-Caliz, I., Aithal, G. P., Arikan, C., Andrade, R. J., & Lucena, M. I. (2022). Therapeutic Management of Idiosyncratic Drug-Induced Liver Injury and Acetaminophen Hepatotoxicity in the Paediatric Population: A Systematic Review. Drug Safety, 45, 1329-1348. https://doi.org/10.1007/s40264-022-01224-w

• Journal Article Type: Article
• Acceptance Date: Aug 4, 2022
• Online Publication Date: Aug 25, 2022
• Publication Date: 2022-11
• Deposit Date: Jul 19, 2023
• Publicly Available Date: Jul 19, 2023
• Journal: Drug Safety
• Print ISSN: 0114-5916
• Electronic ISSN: 1179-1942
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 45
• Pages: 1329-1348
• DOI: https://doi.org/10.1007/s40264-022-01224-w
• Keywords: Pharmacology (medical); Pharmacology; Toxicology
• Public URL: https://nottingham-repository.worktribe.com/output/10367756