DILI Differences and Similarities between the US and Europe

Purpose of review To evaluate the critical role of international registries in understanding idiosyncratic drug-induced liver injury (DILI) by comparing clinical and epidemiological data from the Spanish DILI Registry, the Pro-Euro DILI registry, and the US DILIN. Recent findings Although amoxicillin-clavulanic acid remains the leading global DILI trigger, DILI cases in the US show higher severity and more herbal supplement involvement. Immune checkpoint inhibitors present new toxicity phenotypes. Registry collaborations have yielded advanced prognostic tools like the nR criteria for predicting liver failure, and RECAM, a novel electronic causality assessment scale offering greater diagnostic precision than RUCAM. Summary Registries are crucial for identifying rare DILI events that are missed by clinical trials, as well as for highlighting regional differences in triggers and outcomes. These networks are essential for identifying diagnostic biomarkers, and their findings benefit not only clinicians, but also regulators. Future research should prioritize the global validation of RECAM and utilize multinational biobanks to identify genetic risk factors, ultimately improving drug safety.