Many drugs with different mechanisms of action and indications, available in the market, may induce hepatotoxicity. Drug-induced liver injury (DILI) remains a treatment challenge same as the past. On exploring Medline (via PubMed), CENTRAL, Science Citation Index Expanded, clinical trials registries and databases of DILI and hepatotoxicity for novel therapies for the management of adult patients with DILI based on the combination of three main search terms: 1) treatment, 2) novel, and 3) drug-induced liver injury, the present study was able to extract the mechanism of action of novel therapies, the potential of their benefit in clinical settings, and adverse drug reactions related to novel therapies. 

Cochrane Risk of bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment approach assessed the certainty of the evidence for primary outcomes of included studies. Out of 1372 identified, 28 articles were included in the final analysis. 8 randomized controlled trials (RCTs) were noticed and for 6 the available data were adequate for analysis. 6 studies in abstract form were found and analyzed. The primary outcomes of included trials were laboratory markers improvement. Established on the moderate-certainty evidence, more patients treated with MgIG had alanine aminotransferase (ALT) normalization compared to placebo. Low-certainty evidence indicates that bicyclol treatment causes a decrease in ALT levels than phosphatidylcholine. The remaining eight interventions had the certainty of the evidence for primary outcomes as very low and thus effects were not estimated. 

More effort is needed to investigate the novel treatment of DILI. Well-designed RCTs with appropriate sample sizes, comparable groups and precise are urgently required.

Source- Front Pharmacol. 2022;12:785790. Published 2022 Feb 2. doi:10.3389/fphar.2021.785790