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Amoxicillin/clavulanic-acid/ipilimumab/programmed-cell-death-1-receptor-antagonists

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Immune-related hepatitis and drug-induced liver injury: 11 case reports A retrospective study of 414 patients, who were receiving treatment at an academic hospital between January 2016 and December 2018, described 11 patients including 6 women and 4 men, aged 32–87 years [not all ages and sexes stated] who developed immune-related hepatitis or drug-induced liver injury during treatment with ipilimumab, amoxicillin/clavulanic acid or unspecified programmed-cell-death-1-receptor-antagonists [routes, dosages and outcomes not stated; not all indications and durations of treatments to reactions onsets stated]. The patients had cervical squamous cell carcinoma (2 patients), non small cell lung cancer (1 patient), pancreatic neuroendocrine cancer (1 patient), small cell lung cancer (1 patient), melanoma (5 patients) or unspecified malignancy (1 patient). Three of these patients had liver metastases [data not available for patient with unspecified malignancy]. The patients started receiving immune check point inhibitor therapies comprising ipilimumab (3 patients), ipilimumab + unspecified programmed-cell-death-1-receptorantagonists (7 patients) or unspecified immune checkpoint inhibitor therapy + amoxicillin/clavulanic acid (1 patient). Out of these 11 patients, seven patients had previously received nivolumab (2 patients) or unspecified chemotherapy (5 patients), while three patients had not received any chemotherapy or immune checkpoint inhibitor therapy [data not available for patient with unspecified malignancy]. Ten of these 11 patients developed immune-related hepatitis 2–73 weeks from the initiation of therapy, while the remaining one patient developed drug-induced liver injury. One of these patients had previous history of hepatitis. Liver tests prior to initiation of immunotherapy were within the normal range in all patients with immune-related hepatitis. After immune-related hepatitis, ALT and bilirubin levels were 108–4288 IU/mL and 0.49–9.55 mg/dL, respectively. According to the Roussel Uclaf Causality Assessment Method, the association between immune-related hepatitis and immune checkpoint inhibitor therapy were possible to highly probable. Severity of immune-related hepatitis were mild to moderate. Ten of these 11 patients were treated with immunotherapy discontinuation and unspecified corticosteroids. Three patients required addition of mycophenolate mofetil. Later, two of the patients treated with ipilimumab received immunotherapy retreatment with unspecified programmed-cell-death-1-receptor-antagonists. Riveiro-Barciela M, et al. Immune-related hepatitis related to checkpoint inhibitors: Clinical and prognostic factors. Liver International 40: 1906-1916, No. 8, Aug 2020. 803497742 Available from: URL: http://doi.org/10.1111/liv.14489

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Reactions 22 Aug 2020 No. 1818