Immune-related hepatitis related to checkpoint inhibitors: Clinical and prognostic factors.

Autor: Riveiro-Barciela M; Liver Unit, Internal Medicine Department, Hospital Universitario Vall de Hebrón, Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain., Barreira-Díaz A; Liver Unit, Internal Medicine Department, Hospital Universitario Vall de Hebrón, Barcelona, Spain., Vidal-González J; Liver Unit, Internal Medicine Department, Hospital Universitario Vall de Hebrón, Barcelona, Spain., Muñoz-Couselo E; Oncology Department, Instituto de Oncología Vall d'Hebron (VHIO), Hospital Universitario Vall de Hebrón, Barcelona, Spain., Martínez-Valle F; Systemic Autoimmune Diseases Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain., Viladomiu L; Liver Unit, Internal Medicine Department, Hospital Universitario Vall de Hebrón, Barcelona, Spain., Mínguez B; Liver Unit, Internal Medicine Department, Hospital Universitario Vall de Hebrón, Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain., Ortiz-Velez C; Oncology Department, Instituto de Oncología Vall d'Hebron (VHIO), Hospital Universitario Vall de Hebrón, Barcelona, Spain., Castells L; Liver Unit, Internal Medicine Department, Hospital Universitario Vall de Hebrón, Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain., Esteban R; Liver Unit, Internal Medicine Department, Hospital Universitario Vall de Hebrón, Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain., Buti M; Liver Unit, Internal Medicine Department, Hospital Universitario Vall de Hebrón, Barcelona, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
Jazyk: angličtina
Zdroj: Liver international : official journal of the International Association for the Study of the Liver [Liver Int] 2020 Aug; Vol. 40 (8), pp. 1906-1916. Date of Electronic Publication: 2020 Jun 03.
DOI: 10.1111/liv.14489
Abstrakt: 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 < .001) but duration shorter (2.3 vs 7 months, P < .001) and frequently in monotherapy (41.7% vs 91.3%, P < .001).
Conclusions: Immune-related hepatitis can lead to acute liver failure, with absence of increased values of IgG and ANAs. In contrast to autoimmune hepatitis, initial corticosteroids dose were higher, duration shorter with few requiring additional immunosuppression. Retreatment with CPI was not associated with recurrence.
(© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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