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Western medicine, more so than herbal medicine, contributes to DILI in China

In China, Western medicine may contribute more to drug-induced liver injury than Chinese herbal medicine, according to findings published in the Journal of Gastroenterology and Hepatology.

“The causal relationship between Chinese herbal medicine and liver injury is much complex, and the clinical characteristics of DILI caused by Chinese herbal medicine differ from those caused by Western medicine,” researchers from the China Military Institute of Chinese Medicine, and colleagues wrote. “In this study, [Chinese herbal medicine] was considered as an important but not the most common cause of DILI in China.”

Zhu and colleagues retrospectively studied 1,985 patients with DILI. The mean age of patients in the study was 44 years (range, 0.7-89) with 96.1% of patients older than 18 years. Eight hundred seventy were exclusively on WM, 563 patients were exclusively on CHM and the remainder had taken a combination of the two medicines.

“The characteristics of DILI in China are different from those in Western countries because of the different medication systems, diverse lifestyles, and race-related distinct genetic backgrounds, especially considering the widespread use of [Chinese herbal medicine] in China,” the researchers wrote.

According to researchers, 256 patients were diagnosed with chronic DILI: 

• 112 had been treated with Western medicine (atorvastatin was the most common medication linked to DILI);
• 74 had been treated with a combination of medicines (VitC-yin-qiao tablet was the most common known medication); and
• 70 had been treated with Chinese herbal medicine (an herbal decoction with unknown substances was the most common remedy employed).

Sixty-four patients died:

• 27 had been treated with Chinese herbal medicine
• 24 had been treated with Western medicine (norfloxacin was the most common medication used); and
• 13 had been treated with a combination of medicines, with each taking a unique combination.

Eleven patients underwent a liver transplant:

• seven were on Western medicine, with each taking a unique remedy;
• two were on Chinese herbal medicine (they both took an herbal decoction with unknown substances); and
• two were on a combination of medicines (one took ketoconazole with an herbal decoction with unknown substances for acne and the other took a combination of acitretin, methotrexate and bai-dian-feng).

The remaining 1,651 patients received a “good” prognosis once the agents causing the DILI were cleared from their system and the patients underwent treatment, according to researchers.

The study was not without its limitations, researchers wrote.

“This …. single-center and retrospective survey and was limited by potential selection bias because all of the cases were hospitalized patients, which led to a poor outcome and low presentation in the general population,” researchers wrote. “Thus, there is a need for multicenter and prospective researches to investigate herbal hepatotoxicity and to find the distinctive characteristics of DILI caused by Chinese herbal medicine, and further efforts are needed to study the accurate causal relationship between Chinese herbal medicine and liver injury.” – by Janel Miller

Disclosures: The researchers report no relevant financial disclosures.