KEY TAKEAWAYS
- The study aimed to investigate the management and steroid treatment response of ICI hepatitis.
- The results showed corticosteroids treat ICI hepatitis, with mycophenolate mofetil used for steroid-refractory cases, requiring further research.
Immune checkpoint inhibitors (ICIs) are a cornerstone of cancer treatment, but their use can lead to immune-related adverse events, such as ICI hepatitis. This poses a significant clinical challenge as ICI hepatitis can be severe. While steroids are the standard treatment, cases of steroid-refractory ICI hepatitis are increasing.
Soo Young Hwang and the team aimed to investigate the management of ICI hepatitis and its response to steroid treatment.
A comprehensive search of PubMed/MEDLINE, EMBASE, and CENTRAL databases was conducted in July 2023. The search included keywords such as ICIs (anti-programmed cell death protein 1/programmed death-ligand 1, anti-CTLA-4, and anti-LAG3) and hepatitis.
The database search identified 4358 studies, of which 44 met the inclusion criteria for this systematic review. The analysis included 1856 patients with ICI hepatitis (grade 1-2: 31.7%, grade 3-4: 56.0%, and unknown: 12.3%).
Of these, 1184 patients received corticosteroid treatment. The study found significant variation in treatment duration and dosage across the included studies. Among the 82 cases requiring secondary treatment, mycophenolate mofetil was the most common agent (82.9%), followed by infliximab and azathioprine. The estimated proportion of steroid-refractory hepatitis was 16% (95% CI: 11%-23%). Approximately 40% (95% CI: 30%-51%) of patients with ICI hepatitis were rechallenged with an ICI, with an estimated 22% (95% CI: 15%-30%) recurrence rate.
The study concluded that corticosteroids were the primary treatment for ICI hepatitis, with mycophenolate mofetil used for steroid-refractory cases. Current practices relied on expert consensus, highlighting the need for further research to validate and optimize these treatments, particularly for steroid-resistant cases.
No funding information was given.
Source: https://pubmed.ncbi.nlm.nih.gov/39298568/
Hwang SY, Hsieh P, Zhang W. (2024). “Steroid-refractory immune checkpoint inhibitor (ICI) hepatitis and ICI rechallenge: A systematic review and meta-analysis.” Hepatol Commun. 2024;8(10):e0525. Published 2024 Sep 18. doi:10.1097/HC9.0000000000000525
