Drug-induced liver injury (DILI) remains a challenging diagnosis for physicians, and while there is still no definitive diagnostic biomarker, glutamate dehydrogenase may be more specific than alanine aminotransferase.

Each year, new drugs are implicated as potential hepatotoxins, especially those in the oncology space, including tyrosine kinase inhibitors and checkpoint inhibitors.

The COVID-19 pandemic created numerous challenges for drug development and we discuss liver injury related to COVID-19, including the potential for DILI during its treatment.

New developments in the clinical signatures and mechanisms of injury from previously described hepatotoxins are discussed, including current controversies in the management of immune checkpoint inhibitors and anti-tuberculosis-related DILI.

Novel technologies, including organoid culture systems, that are being developed to predict DILI in drug development and estimate severity of DILI are discussed.