Immune‐related hepatitis related to checkpoint inhibitors: Clinical and prognostic factors

Background & Aims Check point inhibitors (CPI) have improved survival of oncology patients but adverse effects that mimic autoimmune disorders have been reported. Our aim was describe the characteristics of immune‐related hepatitis (irH) and prognosis, and compared them to those of patients with...

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Bibliographic Details
Published in:Liver international 2020-08, Vol.40 (8), p.1906-1916
Main Authors: Riveiro‐Barciela, Mar, Barreira‐Díaz, Ana, Vidal‐González, Judit, Muñoz‐Couselo, Eva, Martínez‐Valle, Fernando, Viladomiu, Lluís, Mínguez, Beatriz, Ortiz‐Velez, Carolina, Castells, Lluís, Esteban, Rafael, Buti, María
Format: Article
Language:English
Subjects:
acute liver failure
Autoimmune diseases
autoimmune hepatitis
checkpoint inhibitors
Corticoids
Corticosteroids
drug‐induced liver injury
Hepatitis
IgG antibody
Immune checkpoint
immune‐related adverse events
immune‐related hepatitis
Immunoglobulin G
Immunosuppression
immunotherapy
Inhibitors
Liver
Liver diseases
Medical prognosis
Oncology
PD-1 protein
PD-L1 protein
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Summary:Background & Aims Check point inhibitors (CPI) have improved survival of oncology patients but adverse effects that mimic autoimmune disorders have been reported. Our aim was describe the characteristics of immune‐related hepatitis (irH) and prognosis, and compared them to those of patients with autoimmune hepatitis (AIH). Methods This is a retrospective study including all grade ≥ 3 (severe) irH diagnosed among 414 patients treated with CPI from 2016 to 2018. Results Twenty‐eight cases of severe irH were recorded: 10 on anti‐CTLA‐4 ± anti‐PD1/PD‐L1 and 18 on anti‐PD1/PD‐L1. Half were female, age 63 years, median time on CPI three cycles. Four (14.3%) presented acute liver injury or failure and one (3.6%) died as consequence. 94% presented normal immunoglobulin G (IgG). Six (21.4%) patients were retreated with CPI and none presented relapse or new immune‐related adverse events after a median cycles of 11 (range 6‐36). Subjects with irH were older and had lower IgG values than a cohort of AIH (N = 38). Presentation tended to be more severe in AIH. Twenty‐five percent of irH and 84% AIH presented ANAs ≥ 1:80 (P = .001). In irH Initial dose of corticosteroids was higher (60 vs 30 mg, P 
ISSN:1478-3223
1478-3231
DOI:10.1111/liv.14489