Secondary Sclerosing Cholangitis due to Drugs With a Special Emphasis on Checkpoint Inhibitors.

Autor: Bjornsson ES; Faculty of Medicine, University of Iceland, Reykjavík, Iceland.; Department of Internal Medicine, Division of Gastroenterology, Landspitali University Hospital Reykjavik, Reykjavík, Iceland., Arnedillo D; Hospital Provincial del Centenario, Rosario, Argentina.; Facultad de Ciencias Mèdicas, National University of Rosario School of Medicine, Rosario, Argentina., Bessone F; Hospital Provincial del Centenario, Rosario, Argentina.; Facultad de Ciencias Mèdicas, National University of Rosario School of Medicine, Rosario, Argentina.
Jazyk: angličtina
Zdroj: Liver international : official journal of the International Association for the Study of the Liver [Liver Int] 2024 Dec 02. Date of Electronic Publication: 2024 Dec 02.
DOI: 10.1111/liv.16163
Abstrakt: Background: Secondary sclerosing cholangitis (SSC), is one of the phenotypes of DILI first described in the 1980s. Check point inhibitors (CPIs) are currently the most frequent cause of SCC.
Aims: To describe the epidemiology, clinical and biochemical features at presentation, differential diagnoses, pathophysiology, imaging, histological characteristics and management associated with SSC.
Materials and Methods: A language and date-unrestricted Medline literature search was conducted to identify case reports and clinical series on SSC with special emphasis on CPIs (2007-2023).
Results: We identified 19 different drugs that have been shown to induce SSC. A total of 64 cases with SSC due to CPIs are presented. This was mostly seen in patients treated with anti-Programmed cell death (PD)-1/PD-L1 inhibitors. The most frequent presenting signs and symptoms were abdominal pain and jaundice. Large-duct cholangitis induced by CPIs is a very rare condition while small-duct cholangitis is more common. Nivolumab and pembrolizumab were the most commonly implicated agents. Biopsies have revealed predominant CD8+ T cell infiltration in biliary strictures. Corticosteroids is linked to a low frequency of success and is the only agent recommended to begin the treatment.
Conclusions: CPIs-induced SSC seems to affect the entire biliary system. Clinicians should consider and suspect SSC when a probable CPIs-induced hepatitis does not respond to corticosteroids. Additionally, further randomized, controlled trials should prospectively investigate alternative therapies for treatment.
(© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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