dc.contributor.author |
Bessone, Fernando |
dc.contributor.author |
Björnsson, Einar Stefán |
dc.date.accessioned |
2023-01-19T01:05:23Z |
dc.date.available |
2023-01-19T01:05:23Z |
dc.date.issued |
2022-07-27 |
dc.identifier.citation |
Bessone , F & Björnsson , E S 2022 , ' Checkpoint inhibitor-induced hepatotoxicity : Role of liver biopsy and management approach ' , World Journal of Hepatology , vol. 14 , no. 7 , pp. 1269-1276 . https://doi.org/10.4254/wjh.v14.i7.1269 |
dc.identifier.issn |
1948-5182 |
dc.identifier.other |
75763978 |
dc.identifier.other |
17110316-4fba-4316-ac86-8739a3e07c9b |
dc.identifier.other |
36158917 |
dc.identifier.other |
PubMedCentral: PMC9376772 |
dc.identifier.other |
85135257078 |
dc.identifier.uri |
https://hdl.handle.net/20.500.11815/3859 |
dc.description |
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved. |
dc.description.abstract |
Immunological checkpoint inhibitors (ICIs) have revolutionized therapy of many different malignanices. Concomitant immune-mediated adverse effects are common and can affect many organs such as the skin, lungs, gastrointestinal and endocrine organs as well as the liver. Liver injury has been reported in 3%-8% of patients with grade III-IV hepatitis in retrospective studies. The liver injury is characterized by hepatocellular injury resembling autoimmune hepatitis biochemically but not immunologically as patients with ICI induced hepatoxicity rarely have auto-antibodies or IgG elevation. The role for liver biopsy (LB) in patients with suspected liver injury due to ICIs is controversial and it is not clear whether results of a LB will change clinical management. LB can be helpful when there is diagnostic uncertainty and pre-existing liver disease is suspected. Although there are no distinctive histological features, the finding of granulomas and endothelitis may suggest a specific type of hepatitis induced by ICIs. The natural history of hepatotoxicity of ICI therapy is not well known. Recent studies have demonstrated that 33%-50% of patients improve spontaneously with discontinuation of ICIs. In patients with jaundice and/or coagulopathy corticosteroids are used. The high doses of corticosteroids with 1-2 mg/kg/d of methylprednisolone recommended by the oncological societies are controversial. Recently it has shown that initial treatment with 1 mg/kg/d provided similar liver tests improvement which was also associated with a reduced risk of steroid-induced adverse effects in comparison with higher-dose regimens. Secondary immunosuppression mostly with mycophenolate mofetil has been reported to be helpful. |
dc.format.extent |
8 |
dc.format.extent |
4249402 |
dc.format.extent |
1269-1276 |
dc.language.iso |
en |
dc.relation.ispartofseries |
World Journal of Hepatology; 14(7) |
dc.rights |
info:eu-repo/semantics/openAccess |
dc.subject |
Meltingarlæknisfræði |
dc.title |
Checkpoint inhibitor-induced hepatotoxicity : Role of liver biopsy and management approach |
dc.type |
/dk/atira/pure/researchoutput/researchoutputtypes/contributiontojournal/article |
dc.description.version |
Peer reviewed |
dc.identifier.doi |
10.4254/wjh.v14.i7.1269 |
dc.contributor.department |
Office of Division of Clinical Services I |
dc.contributor.department |
Faculty of Medicine |