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Cited by 73

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

Li, Michael, Wong, Danny, Vogel, Alexander S., Sack, Jordan S., Rahma, Osama E., Hodi, F. Stephen, Zucker, Stephen D., Grover, Shilpa·2022·Hepatology
DOI 10.1002/hep.32215
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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.

Overview

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Crossref · 10.1002/hep.32215

Cites

25 of 25 references verified0 citation errors · 0 not checkable

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Citations

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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
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-12-07
Volume
75
Issue
3
Pages
531-540
ISSN
  • 0270-9139
  • 1527-3350
DOI
10.1002/hep.32215
Cited by
73
References
25
Language
en
Licence

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Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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