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Non‐alcoholic fatty liver disease is a potential risk factor for liver injury caused by immune checkpoint inhibitor
Author(s) -
Sawada Koji,
Hayashi Hidemi,
Nakajima Shunsuke,
Hasebe Takumu,
Fujiya Mikihiro,
Okumura Toshikatsu
Publication year - 2020
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14889
Subject(s) - medicine , nivolumab , fatty liver , gastroenterology , risk factor , hazard ratio , adverse effect , liver injury , pembrolizumab , disease , cancer , immunotherapy , confidence interval
Background and Aim Because of their survival benefits, immune checkpoint inhibitors (ICIs) are widely administered to patients with various advanced‐stage malignancies. During ICI treatment, drug‐induced liver injury (DILI) occasionally occurs. In particular, hepatic immune‐related adverse events (irAEs) are rare but serious and fatal. In patients with hepatic irAEs, immediate steroid treatment is generally recommended; however, the risk factors for ICI‐associated DILI remain unknown. In the present study, we identified a risk factor for ICI‐associated DILI. Methods We retrospectively analyzed 135 patients treated with anti‐programmed cell death‐1 (PD‐1) antibodies, such as nivolumab and pembrolizumab, at Asahikawa Medical University Hospital. We investigated grade ≥ 2 hepatotoxic AEs during anti‐PD‐1 therapy, and PD‐1 inhibitor‐associated DILI was then diagnosed according to the Digestive Disease Week Japan (DDW‐J) 2004 scale. The risk factors for PD‐1 inhibitor‐associated DILI were identified by Cox hazard analysis. Results Thirty‐six patients developed grade ≥ 2 hepatic AEs during anti‐PD‐1 therapy. Among them, eight patients were diagnosed with PD‐1 inhibitor‐associated DILI based on the DDW‐J 2004 scale. Cox hazard analysis revealed that non‐alcoholic fatty liver disease (NAFLD) was a risk factor for PD‐1 inhibitor‐associated DILI. In addition, we revealed that the outcomes of patients with the DDW‐J 2004 score = 3 were improved without steroid treatment. Conclusions NAFLD is a potential risk factor for PD‐1 inhibitor‐associated DILI based on the DDW‐J 2004 scale. The DDW‐J 2004 scale might be useful for determining whether steroid treatment is required in patients with PD‐1 inhibitor‐associated DILI.