Under-reporting and Poor Adherence to Monitoring Guidelines for Severe Cases of Isoniazid Hepatotoxicity

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
Paul H HayashiUS Drug-Induced Liver Injury Network Investigators

Abstract

Isoniazid is a leading cause of liver injury but it is not clear how many cases are reported or how many clinicians and patients adhere to American Thoracic Society (ATS) guidelines. We collected data on cases of isoniazid hepatotoxicity and assessed adherence to ATS guidelines and reports to the Centers for Disease Control's (CDC) isoniazid severe adverse events program. We analyzed Drug-Induced Liver Injury Network (DILIN) cases considered definite, highly likely, or probable for isoniazid injury from 2004 through 2013. We assessed the delays in isoniazid discontinuance according to ATS criteria and hepatotoxicity severity by Severity Index Score. We checked reporting to the CDC by matching cases based on age, latency, indication, reporting period, and comorbidities. Isoniazid was the second most commonly reported agent in the DILIN, with 69 cases; 60 of these met inclusion criteria. The median age of cases was 49 years (range, 4-68 y), 70% were female, 97% had latent tuberculosis, and 62% were hospitalized. Patients took a median of 9 days to stop taking isoniazid (range, 0-99 days). Thirty-three cases (55%) continued taking isoniazid for more than 7 days after the ATS criteria for stopping were met. Twenty-four cases (40%) ...Continue Reading

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Citations

Dec 4, 2015·Expert Review of Gastroenterology & Hepatology·Jonathan G Stine, James H Lewis
Jun 28, 2015·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·James H Lewis
May 2, 2015·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Raúl J Andrade
Apr 20, 2016·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Rolf Teschke, Gaby Danan
May 5, 2016·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Philip SargesJames H Lewis
Apr 30, 2016·International Journal of Molecular Sciences·Christian Frenzel, Rolf Teschke
Oct 7, 2016·Acta Pharmaceutica Sinica. B·Pengcheng WangXiaochao Ma
Feb 1, 2017·Journal of Applied Toxicology : JAT·Rika HirashimaRyoichi Fujiwara
Jun 28, 2019·Clinical Pharmacology and Therapeutics·Cong HuaiShengying Qin
Mar 25, 2020·Current Opinion in Gastroenterology·Hans L Tillmann, Don C Rockey
Feb 5, 2021·Journal of Hepatology·Camilla StephensUNKNOWN Participating clinical centres
Sep 18, 2021·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Joseph William ClintonJames H Lewis

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