title: Steroid and ursodesoxycholic Acid combination therapy in severe drug-induced liver injury.
abstract: BACKGROUND
  Drug-induced liver injury (DILI) is the leading cause of acute severe liver disease in Western countries. Treatment strategies for DILI are still not well defined.
  
  
  OBJECTIVE
  We studied the safety and outcomes of steroid/ursodesoxycholic acid (UDCA) combination therapy in DILI patients.
  
  
  METHODS
  15 consecutive patients with severe DILI were analyzed for clinical, biochemical and histological data. Nine patients were treated with a steroid step-down therapy with reduction of the daily dose over several weeks; 6 patients received a steroid pulse therapy for 3 days. UDCA was administered for several weeks in both groups.
  
  
  RESULTS
  Patients without histological signs of preexistent liver damage (n = 10) showed the most favorable clinical course. Bilirubin and serum transaminases dropped to <50% of peak values within 2 weeks, and normalized within 4-8 weeks. In contrast, patients with positive autoimmune antibodies (anti-nuclear antibodies and/or soluble liver antigen) and/or histological features of chronic hepatitis (n = 3) exhibited a slower reduction in bilirubin and serum transaminase levels. These patients were given immunosuppressants (steroids, azathioprine) for a further 6 months.
  
  
  CONCLUSIONS
  Treatment of severe DILI with corticosteroids (both pulse and step-down therapy) and UDCA appears to be safe, and leads to a more rapid reduction in bilirubin and transaminases after DILI.
authors.affiliation: Department of Gastroenterolgy and Hepatology, University Hospital Essen, Essen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Wree
authors.forename: Alexander
authors.initials: A
authors.lastname: Dechêne
authors.forename: Kerstin
authors.initials: K
authors.lastname: Herzer
authors.forename: Phillip
authors.initials: P
authors.lastname: Hilgard
authors.forename: Wing-Kin
authors.initials: WK
authors.lastname: Syn
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Ali
authors.initials: A
authors.lastname: Canbay
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy* / Q000473:pathology; D002756:Cholagogues and Choleretics / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000188:drug therapy / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid; D011241:Prednisone