00069837

June 19, 2021, 16:13

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This is an interesting systematic review by Becker et al. that analyzes DILI publications in Brazil. The authors carried out a thorough search of the main sources over a long period of time including several decades. One of the limitations concerning several of the published studies reporting DILI is that the cut-off points taken by many of the analyzed papers are not based on the current definition of DILI, which takes as a cut-off point ALT/AST higher than 5 times the upper limit of normal and stated during an expert meeting report in 2011 (Aithal et al. Case definition and phenotype standardization in drug-induced liver injury.Clin Pharmacol Ther 2011;89:806–15, ). This issue casts doubt on many diagnoses of hepatotoxicity because most of these biochemical episodes could have been an adaptive phenomenon, very frequent in clinical practice and observed at the beginning of drug intake, which after some time of drug consuming, liver tests become normal despite continued consumption of the drug. Another DILI confounding factor is hepatitis E (HEV), which is endemic in several countries of latin america and in most liver toxicity reports is not properly ruled out. Latin America and Brazil in particular, also have several tropical diseases that can be confused with liver adverse reactions and they were not properly ruled out in most DILI reports The authors very clearly presents the selected articles, however, the results are not presented in detail and had been insufficiently developed in order for the reader to understand the true magnitude of the deficiencies in DILI's reporting in Brazil. The discussion is too extensive and does not focus on the value of the DILI registries, where Latin America already has its own (LATINDILI), which is working since 2011 and has several publications (none of which are cited), showing a DILI recruitment higher than 300 cases. These DILI registries, besides helping to know which are the regional prevalence of liver toxicity induced by drugs and herbs, also represent an important help to the regulatory authorities of each country. The joint work between researchers and the corresponding Ministries of Health should be stimulated due to the high impact that hepatotoxicity represent for public health. Finally, it is worth mentioning that a DILI management guide based on Latin American data has already been published. It it is very comprehensive review and orients the reader on how to base the diagnosis, management and where to look for appropriate information of each drug suspected of hepatotoxicity (Bessone F. et al. Annals of Hepatology 24 (2021) 1003-21)

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