Drug and herb induced liver injury: Council for International Organizations of Medical Sciences scale for causality assessment

Table 8 Compilation of causality assessment methods used in suspected herb induced liver injury cases

Herbs/Herbal products	Ad hoc (n)	WHO (n)	CIOMS (n)	Naranjo (n)	DILIN (n)	KL (n)	Ref.
Kava	20						BfArM[58]
Kava		30					Denham et al[59]
Kava	20						Teschke et al[60]
Kava			36				Stickel et al[61]
Kava		80					Schmidt et al[62]
Greater Celandine	23						BfArM[63]
Black cohosh			31				EMA[54]
Herbalife products		12					Elinav et al[64]
Herbalife products		12					Schoepfer et al[65]
Kava			26				Teschke et al[12]
Black cohosh				30			Mahady et al[42]
Green tea				34			Sarma et al[43]
Black cohosh			4				Teschke et al[47]
Black cohosh			9				Teschke et al[48]
Kava			31				Teschke[34]
Hydroxycut					17		Fong et al[66]
Black cohosh			22				Teschke et al[36]
Greater Celandine			22				Teschke et al[37]
Herbalife products						20	Manso et al[67]
Various herbs			45				Chau et al[57]
Greater Celandine			21				Teschke et al[32]
Pelargonium sidoides			15				Teschke et al[38]
Pelargonium sidoides			13				Teschke et al[39]
Sum (n)	63	134	275	64	17	20
Sum (percent)	11.00%	23.40%	48.00%	11.20%	3.00%	3.40%

The data are derived from a study evaluating alternative causes in suspected HILI cases (n = 573) comprising the study cohort[5]. For the 275 CIOMS cases, causality assessment was performed with the updated CIOMS scale the original CIOMS scale, or both. Ad hoc: ad hoc approach; CIOMS: Council for International Organizations of Medical Sciences scale; DILIN: Drug Induced Liver Injury Network method; KL: Karch and Lasagna method; Naranjo: Naranjo scale; WHO: World Health Organization method.