The influence of drug properties and host factors on delayed onset of symptoms in drug‐induced liver injury

Background & Aims Most patients with drug‐induced liver injury (DILI) manifest clinical symptoms while on therapy, while some patients manifest days or weeks after drug cessation (delayed onset). This challenges DILI causality assessment and diagnosis. Factors contributing to the delayed onset phenotype are currently unknown. We explored factors contributing to delayed onset of DILI by analysing culprit drug properties, host factors and their interactions in a large patient population from the Spanish DILI Registry. Methods Clinical information from 388 patients (69 presented delayed onset) and drug properties of 43 causative drugs (45 active ingredients) were analysed. A two‐tier regression‐based model was used to assess host/drug interactions affecting the probability of delayed onset. Results Antibacterial and anti‐inflammatory drugs accounted for the delayed onset cases. Drug property of