Prospective study of patients with immune checkpoint inhibitor-induced hepatitis; characterization of liver injury, outcome of therapy, and management of steroid-unresponsive and steroid-dependent hep
5 days ago
- #hepatotoxicity
- #immune checkpoint inhibitors
- #immunosuppression
- Prospective study on immune checkpoint inhibitor-induced hepatitis (ir-hepatitis) in patients.
- 34 patients with grade 3-4 ir-hepatitis included; 59% responded to steroids, 18% were steroid-unresponsive, and 23% were steroid-dependent.
- Steroid-unresponsive and steroid-dependent patients required higher accumulated steroid doses.
- Alcohol consumption and male sex linked to inadequate steroid response.
- Mixed drug-induced liver injury (DILI) had the highest steroid response rate (72%), while cholestatic DILI had the worst prognosis.
- Mycophenolate mofetil (MMF) used as secondary immunosuppressant for steroid-unresponsive cases.
- Liver biopsies showed increased T cell infiltration in ir-hepatitis.
- Single-cell RNA sequencing revealed CD8+ effector T cell clonal expansion in steroid-unresponsive cases.
- Study highlights need for alternative treatments in steroid-unresponsive ir-hepatitis.