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Q&A - Drug induced liver injury: update 2018
Guruprasad P. Aithal, Digestive Diseases Centre, University of Nottingham, Nottingham, Great Britain
Thursday, Nov. 1, 2018 · 7:30 p.m. · 11m 09s
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yeah we have time for questions anybody as a question
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i think you know question because the code aesthetic really
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uh oh was when the bridges and i when he said that's a significant
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proportion of what has been attribute it ideally met beach activities e.
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so what do you think of this no uh is down so um i
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think it came from a us um it is a confound the um
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i think it came from one see this from us where they found about
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ten percent of patients where a blamed as billy turned out rapidly
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um i would say that proportion varies from how well you how worked up what publication
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it is a gentleman uh issue because the reason to pass that's why would just really trying to
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tell you that make the actors about uh improve backers of by the by using that that
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you know local hard really uh uh we go through protocols of pass um
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and so the those that i showed you are or
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from international colour consortium and it's not really confounded
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if you look at how good how accurately the diagonal somebody doesn't even g. or not
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the data uh doesn't come from a um last year so i didn't show you but i showed up
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best thirty came from late nineties ten thousand patiently joined is
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latter evaluated in a european program called a euro
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you because that was the program is were designed by i think i. t. guys who are trying to develop um
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uh almost like an artificial intelligence at the time was not
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that intelligent but the computer programs to diagnose conditions
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so ten thousand patients are equal to from about twenty plus
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countries hundred fifty was built in euro precluded patients and
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their i'll though that was very very simple so they had
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the interested guess control is mainly a hamper colleges
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we'll see a patient they can't put all the information they have got and then they like the diagnosis
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and then they do whatever they want and then ride their final diagnosis okay
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so in other words you decide how good your like was was
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in that study reading a little under diagnosis was forty five percent active it
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this is for special is what interest in it which means that we're not good at diagnosing
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was was that it was third from the bottom which means that they're good at like there's a lot of things but not would be delivered
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in that's thirty the a complete all the them that developed the base
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in moderately compare diagnosis was about sixty five percent something like that
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so even that wasn't that good so which means that my my uh um
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philosophy is that you know you probably know the they'll condiment
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does anybody know did mail condiment no yes yeah yeah
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yes yes he he got a nobel prize he's a psychologist who what nobel prize for economy
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so is it a noble coloured thinking fast and slow and that this is one
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thing you shouldn't relating to fast enough thinking part is that social life
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if you think about everything then that too long life will compose landing hard but
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those things which are important you can't do fast it's bizarre i seven systematic
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evaluation you got all the domains of what can it really exclude
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what the temporal profile has been what other export as being then come to a
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conclusion i think we don't do that that's why we get the diagnosis or
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sorry long window down so
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there's not a question that's right i preceded really the told to just a
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a more features a philosophical question to really want to know your
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opinion as an expert it so it looks like in all the d.
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v. d. that you think that the reason a genetic background
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so do you leave a space and if you do so which percentage on
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the hypothesis that the individual susceptibility a predisposition does not do too
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divide into the gene that we've received but actually to environmental
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nutrients metabolic all fat accumulation in the lever mitochondria
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and she uh your idea is that
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the percentage that where we don't know the genetic what it is because
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we're not good enough to find eat or do you leave a space
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to the way we leave in dependent on the genetic variance is
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always an alignment effective i would say i calculate the percentage but i
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would say actually is more than fifty percent is an wonderment
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um but if you go by the knowledge we have gained um
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it looks like the heartbreak specific factors and like
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those matters um in a small small way
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if you take it to the pretty claims that is a study is at least two studies showing that if
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you are related to the putting those is less than five milligrams compared to fifty or a hundred milligrams
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that drug is more likely to cost toxicity if you have a higher goals
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that supports what i said actually something to do with the drug is equally important it's
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just that we cannot have so many highly efficacious products that aren't really any
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so you can't really don't every drug which is more than five million dollars because it's got some
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chance of causing have cox it so there are a lot of in one of the factors
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um what we have control on it might might have was
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also comes because i don't know oneself singularly failed
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to maybe make the didn't live in the best one which came from is you tracked
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this was probably should twenty sixteen i think capital with daddy created how my their queen toxicity
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why actually marking out a c. t. l. uh for you as well as inhibiting pretty uh pretty one soul
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but it only works for them and i clean toxicity it doesn't what what others
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that is why i just uh wanted really explore the identity factors because
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one thing blending different uh is that i know we have got ninety six
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percent or more likely with the uh uh on my is but
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we have got how more like even banana forfeit forty percent haven't yet so uh so
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we just had to really use humans that's why why the point is important
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thank you very much just a very short question which i think menu bust facing clinical product is so
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it's a rather old emmy important and and like easy to think about d.
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lee if yeah but young patient that that the exposure to one drug
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but would we seen playing upright disease that we are called on the word for quite old patient can do the altar with an acute
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condition receipts settle drugs so dick and then they develop items i
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mean eases or colours daisies and then you are asked what
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what should i stop and then there are several possible candidates that you should
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stop yeah what do you do to stop every only the yeah it's
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um i kind of use as much um data that is so basically
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uh this is where you need to use half out all the tasks that are really if you have got
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someone was on call marks a clever as well as some many other drugs i've got
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an italic aghast i still do if it's positive then that are on that side
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um i usually uh my rule is for this with three months is the key period i tell our them to
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see well which one is in that time frame compared to
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the event so that is the most likely suspect
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then extended for that year so barring exceptions like in a
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stack a loose um psych leans minutes like lines
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a big can cost begin it would almost characteristically after some time
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most of the books come between for this two three months and then i i follow that temporal relationship
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and i'm on the fact that i use is that signature pattern that
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isn't really very maybe of them but if you have got
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typical autumn inhabit id like manifestation them i know that only few bucks which can cause it
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so you go by the thing with the patent type i would say that if you're books have
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like i would say very hardcore config with the patent but middle cycling this one of them
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i would say um anabolic still in some of the matter is
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really no controversy always cost what is that about that
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so use use also the points i would use really kind of a nail down
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but sometimes you can't commanded the blocks we still don't know which of these drug is the most toxic so then you
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need to really we introduce based on the odds ratio and then check if it is important otherwise the open boat
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maybe going measured make your maybe one short funny question from time to time we have patients saying
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that day or the cheek against everything or at least against a whole bunch of trucks
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so tightly she does it oh node is probably not to got to research president goes in
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a direction we're you could assume that there's a come possibly you think these patients could
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exist in fact or is it yeah there are there are publications
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i think uh well we'll see blue published that may be
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three four years ago or there are people with i mean that's syndrome is a classic example dress syndrome you all know
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is the uh actually a poly good i think it farther maybe is what it was hypersensitivity
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and people have that in a very small quarter patients ironically
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they do have t. cell regulate we eh abnormalities
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so it's very small study published nobody the more general so people don't really i'm not about
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of it now appeared to be an twenty two brings that quest actually when i
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when i was with the i'm archiving gone from the f. d. a. in a
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meeting a few months ago he was just saying well we have always
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excluded this ever possibly guy said well just wait delay sally i'll tell you i i i'll tell you down for
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so that is it yes yes it is a reality i don't know we had i don't think we have many many
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dress syndrome patients but that is an overlap that one of the paper which i didn't really present which is
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uh and review where we have got a um common uh teletext predisposition between governments the pain
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daily and cobb opens the beans skin hypersensitive it so badly there is definitely an overlap
Conference Program
FXR/FGF19 gut liver axis – new therapeutic strategies
Antonio Moschetta, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
Nov. 1, 2018 · 6:04 p.m.
113 views
