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A novel phenotype‐based drug‐induced liver injury causality assessment tool (DILI‐CAT) allows for signal confirmation in early drug development
BACKGROUND: Drug‐induced liver injury (DILI) requires accurate case adjudication, with expert opinion being the current best practice. AIM: We utilised a novel DILI causality assessment tool (DILI‐CAT), which uses drug‐specific liver injury phenotypes, to examine potential DILI in early phase ximela...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9164935/ https://www.ncbi.nlm.nih.gov/pubmed/35266155 http://dx.doi.org/10.1111/apt.16836 |
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author | Hermann, Richard P. Rockey, Don C. Suzuki, Ayako Merz, Michael Tillmann, Hans L. |
author_facet | Hermann, Richard P. Rockey, Don C. Suzuki, Ayako Merz, Michael Tillmann, Hans L. |
author_sort | Hermann, Richard P. |
collection | PubMed |
description | BACKGROUND: Drug‐induced liver injury (DILI) requires accurate case adjudication, with expert opinion being the current best practice. AIM: We utilised a novel DILI causality assessment tool (DILI‐CAT), which uses drug‐specific liver injury phenotypes, to examine potential DILI in early phase ximelagatran clinical development. METHODS: We conducted a retrospective analysis of liver injury events from four Stroke Prevention using an ORal Thrombin Inhibitor in Atrial Fibrillation (SPORTIF) trials, in which patients were randomised to receive oral ximelagatran or adjusted‐dose warfarin. A stepwise process was used with iterative adjustments. The DILI phenotype was characterised by latency, R‐value, and AST/ALT ratio. A scoring algorithm was applied to liver events to assess how closely the liver events matched the Interquatile‐Range for the working phenotype for each of the three parameters. FINDINGS: Data from 3115 patients included in the SPORTIF trials as above were available. The initial ximelagatran phenotype was developed based on five liver injury cases from the ximelagatran arm and was then validated against an additional eight cases (5 ximelagatran, 3 warfarin); in these eight cases, there was a statistically significant difference in the total DILI‐CAT scores of the two drugs (p = 0.016) between ximelagatran and warfarin. Together, these ten ximelagatran cases generated a second, refined ximelagatran phenotype, which was validated against an additional 75 cases (53 ximelagatran/22 warfarin)—again with statistically significant different DILI‐CAT ximelagatran vs. warfarin scores (p < 0.001). CONCLUSION: DILI‐CAT, a clinically intuitive, data‐driven, computer‐assisted scoring algorithm, is a useful tool for early detection of drug’s hepatotoxicity in clinical drug development. |
format | Online Article Text |
id | pubmed-9164935 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-91649352022-10-14 A novel phenotype‐based drug‐induced liver injury causality assessment tool (DILI‐CAT) allows for signal confirmation in early drug development Hermann, Richard P. Rockey, Don C. Suzuki, Ayako Merz, Michael Tillmann, Hans L. Aliment Pharmacol Ther Dili‐cat ‐ a New Tool for Detection of Early Drug Induced Liver Injury BACKGROUND: Drug‐induced liver injury (DILI) requires accurate case adjudication, with expert opinion being the current best practice. AIM: We utilised a novel DILI causality assessment tool (DILI‐CAT), which uses drug‐specific liver injury phenotypes, to examine potential DILI in early phase ximelagatran clinical development. METHODS: We conducted a retrospective analysis of liver injury events from four Stroke Prevention using an ORal Thrombin Inhibitor in Atrial Fibrillation (SPORTIF) trials, in which patients were randomised to receive oral ximelagatran or adjusted‐dose warfarin. A stepwise process was used with iterative adjustments. The DILI phenotype was characterised by latency, R‐value, and AST/ALT ratio. A scoring algorithm was applied to liver events to assess how closely the liver events matched the Interquatile‐Range for the working phenotype for each of the three parameters. FINDINGS: Data from 3115 patients included in the SPORTIF trials as above were available. The initial ximelagatran phenotype was developed based on five liver injury cases from the ximelagatran arm and was then validated against an additional eight cases (5 ximelagatran, 3 warfarin); in these eight cases, there was a statistically significant difference in the total DILI‐CAT scores of the two drugs (p = 0.016) between ximelagatran and warfarin. Together, these ten ximelagatran cases generated a second, refined ximelagatran phenotype, which was validated against an additional 75 cases (53 ximelagatran/22 warfarin)—again with statistically significant different DILI‐CAT ximelagatran vs. warfarin scores (p < 0.001). CONCLUSION: DILI‐CAT, a clinically intuitive, data‐driven, computer‐assisted scoring algorithm, is a useful tool for early detection of drug’s hepatotoxicity in clinical drug development. John Wiley and Sons Inc. 2022-03-09 2022-04 /pmc/articles/PMC9164935/ /pubmed/35266155 http://dx.doi.org/10.1111/apt.16836 Text en © 2022 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Dili‐cat ‐ a New Tool for Detection of Early Drug Induced Liver Injury Hermann, Richard P. Rockey, Don C. Suzuki, Ayako Merz, Michael Tillmann, Hans L. A novel phenotype‐based drug‐induced liver injury causality assessment tool (DILI‐CAT) allows for signal confirmation in early drug development |
title | A novel phenotype‐based drug‐induced liver injury causality assessment tool (DILI‐CAT) allows for signal confirmation in early drug development |
title_full | A novel phenotype‐based drug‐induced liver injury causality assessment tool (DILI‐CAT) allows for signal confirmation in early drug development |
title_fullStr | A novel phenotype‐based drug‐induced liver injury causality assessment tool (DILI‐CAT) allows for signal confirmation in early drug development |
title_full_unstemmed | A novel phenotype‐based drug‐induced liver injury causality assessment tool (DILI‐CAT) allows for signal confirmation in early drug development |
title_short | A novel phenotype‐based drug‐induced liver injury causality assessment tool (DILI‐CAT) allows for signal confirmation in early drug development |
title_sort | novel phenotype‐based drug‐induced liver injury causality assessment tool (dili‐cat) allows for signal confirmation in early drug development |
topic | Dili‐cat ‐ a New Tool for Detection of Early Drug Induced Liver Injury |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9164935/ https://www.ncbi.nlm.nih.gov/pubmed/35266155 http://dx.doi.org/10.1111/apt.16836 |
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