Empagliflozin-Induced Liver Injury

Area of Science:

• Hepatology
• Pharmacology
• Endocrinology

Background:

• Drug-induced liver injury (DILI) is an uncommon adverse reaction with varied presentations.
• Sodium-glucose cotransporter 2 (SGLT2) inhibitors are widely used for type 2 diabetes, generally considered liver-safe.
• Rare instances of DILI linked to SGLT2 inhibitors necessitate vigilance.

Purpose of the Study:

• To report a case of cholestatic DILI in a patient treated with empagliflozin.
• To highlight the importance of systematic evaluation and causality assessment in suspected SGLT2 inhibitor-associated hepatotoxicity.

Main Methods:

• A 56-year-old male with type 2 diabetes developed cholestatic liver injury after initiating empagliflozin.
• Diagnostic work-up excluded other causes of liver dysfunction.
• Causality was assessed using established scoring systems (Roussel Uclaf Causality Assessment Method, Maria and Victorino, Naranjo).
• Liver biopsy confirmed acute cholestatic injury.

Main Results:

• The patient presented with jaundice and elevated cholestatic liver enzymes.
• Empiric exclusion of other liver injury etiologies was performed.
• Causality assessment indicated a probable link between empagliflozin and liver injury.
• Liver biopsy findings were consistent with drug-induced cholestatic injury.
• Discontinuation of empagliflozin led to clinical and biochemical improvement.

Conclusions:

• Empagliflozin can rarely induce idiosyncratic cholestatic DILI, even in patients with cirrhosis.
• Early identification, drug withdrawal, and thorough evaluation are crucial for managing SGLT2 inhibitor-associated hepatotoxicity.
• This case contributes to the understanding of rare SGLT2 inhibitor-induced liver injury.