A real-world study of immune mediated hepatitis induced by immune checkpoint inhibitors
Objective To determine the clinical features,risk factors,treatment plan and prognosis of immune checkpoint inhibitors(ICIs)-induced immune mediated hepatitis(IMH),and provide evidence for clinical identification of high-risk patients with IMH,for clinical treatment and prognosis evaluation of patients with IMH.Methods The clinical data of tumor patients with IMH after receiving ICIs in our hospital from July 2021 to July 2022 were collected,and the clinical features,risk factors,treatment plan and prognosis of IMH were analyzed.Results The incidence of IMH was 6.6％,and the incidence of≥ grade 3 IMH reached 6.2％.About 70.7％of IMH occurred within 3 months of the treatment,34.1％of IMH showed asymptomatic elevated aminotransferase,while 65.9％of IMH showed systemic skin sclera yellow staining or weakness.About 43.9％of IMH belonged to hepatocyte injury type,36.6％cholestasis type and 19.5％mixed type.The incidence of IMH was an important index in the liver metastasis and combination therapy.Thirty-nine patients with IMH were improved after active treatment with glucocorticoids or combined with mycophenolate morpheate,tacrolimus and other drugs.One patient had liver failure after glucocorticoid monotherapy with poor effect,and another had liver failure after drug withdrawal without treatment.After 6 months of follow-up,IMH recurred in 4 patients and no IMH recurred in 2 of them after ICIs reuse.Conclusion The overall incidence of IMH is not related to age,sex,body mass index and history of hepatitis B.Primary tumor type,liver metastasis and drugs combination are the risk factors for IMH.The prognosis of IMH is generally good with low recurrence.
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