The DOI matches its Crossref record; 25 of the 25 references it cites were found in a registry or an index.
Effect of corticosteroid dosing on outcomes in high‐grade immune checkpoint inhibitor hepatitis
Abstract
Background and Aims: Consensus guidelines recommend high‐dose corticosteroids (1–2 mg/kg/day methylprednisolone equivalents) for treating grade ≥3 immune checkpoint inhibitor (ICI) hepatitis. We examined the effect of corticosteroid dosing on time to alanine aminotransferase (ALT) normalization, need for additional immunosuppression, and steroid‐related complications. Approach and Results: We conducted a retrospective cohort study of 215 ICI‐treated patients from 2010 to 2020 who developed grade ≥3 (ALT > 200 U/L) ICI hepatitis. Patients were grouped by initial corticosteroid dose (≥1.5 mg/kg or <1.5 mg/kg methylprednisolone equivalents). Propensity scores were calculated predicting the risk of receiving the higher steroid dose and used in inverse probability of treatment weighted (IPTW) logistic or Cox regression. The 87 patients in the ≥1.5 mg/kg group received higher initial (2.0 vs. 0.8 mg/kg/day, p < 0.001) and maximum (2.0 vs. 1.0 mg/kg/day, p < 0.001) steroid doses than the 128 patients in the <1.5 mg/kg group. There was no difference between the higher versus lower‐dose groups in development of steroid‐refractory hepatitis (OR 1.22, 95% CI 0.79–1.89, p = 0.365) on IPTW‐logistic regression. In patients with steroid‐responsive disease, there was no difference between the two groups in time to ALT normalization using either standard Cox regression (HR 1.02, 95% CI 0.72–1.45, p = 0.903) or IPTW‐Cox regression (HR 1.09, 95% CI 0.78–1.51, p = 0.610). The ≥1.5 mg/kg group had longer exposure to corticosteroids (median 60 vs. 44 days, p = 0.005) and higher incidences of infection (18.4% vs. 7.0%, relative risk [RR] 2.6, 95% CI 1.2–5.6, p = 0.011) and hyperglycemia requiring treatment (23.3% vs. 7.8%, RR 3.0, 95% CI 1.5‐6.0, p = 0.001). Conclusions: In patients with high‐grade ICI hepatitis, initial treatment with 1 mg/kg/day methylprednisolone equivalents provides similar hepatitis outcomes with reduced risk of steroid‐related complications when compared with higher‐dose regimens.
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“In a retrospective analysis of patients with high-grade ILICI who received initial doses of either ≥1.5 mg/kg versus <1.5 mg/kg methylprednisolone equivalents, there was no difference in time to normalization of ALT or development of steroid-refractory disease.”
From The contemporary epidemiology, causes, and management of drug-induced liver injury (2026) · cites this paper as [76]
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Hodi, F. S., Chiarion-Sileni, V., Gonzalez, R., Grob, J.-J., Rutkowski, P., Cowey, C. L., Lao, C. D., Schadendorf, D., Wagstaff, J., Dummer, R., et al. (2018) · The Lancet Oncology · doi:10.1016/s1470-2045(18)30700-9 · Cited by 1,399
Cited by
Liu, Z., Zhu, Y., Xie, H., & Zou, Z. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2022.1077468 · Cited by 77
Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update
Mao, Y., Ma, S., Liu, C., Liu, X., Su, M., Li, D., Li, Y., Chen, G., Chen, J., Chen, J., et al. (2024) · Hepatology International · doi:10.1007/s12072-023-10633-7 · Cited by 62
The contemporary epidemiology, causes, and management of drug-induced liver injury
Swanson, L., & Fontana, R. J. (2026) · Hepatology Communications · doi:10.1097/hc9.0000000000001011
Metadata
- Authors
- Li, M., Wong, D., Vogel, A. S., Sack, J. S., Rahma, O. E., Hodi, F. S., Zucker, S. D., & Grover, S.
- Affiliations
- Division of Gastroenterology, Hepatology, and Endoscopy,Brigham & Women’s Hospital,Boston,Massachusetts,USA
- Harvard Medical School,Boston,Massachusetts,USA
- ORCID
- Li, Michael
- Venue
- Hepatology
- Published
- 2021-12-07
- Volume
- 75
- Issue
- 3
- Pages
- 531-540
- ISSN
- 0270-9139
- 1527-3350
- Cited by
- 73
- References
- 25
- Language
- en
- Licence
- onlinelibrary.wiley.com/termsAndConditions#vor (vor)
- doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
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- Li, M., Wong, D., Vogel, A. S., Sack, J. S., Rahma, O. E., Hodi, F. S., Zucker, S. D., & Grover, S. (2022). Effect of corticosteroid dosing on outcomes in high‐grade immune checkpoint inhibitor hepatitis. Hepatology. https://doi.org/10.1002/hep.32215
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