Hepatic failure associated with immune checkpoint inhibitors: An analysis of the Food and Drug Administration Adverse...

Hepatic failure induced by immune checkpoint inhibitors (ICIs) has been reported in only a few case series and case reports.

We aimed to explore the association between ICIs and hepatic failure and characterize the clinical features of ICI-associated hepatic failure in the pharmacovigilance database.

Data from the first quarter (Q1) of 2015 to the fourth quarter (Q4) of 2021 in the US Food and Drug Administration Adverse Event Reporting System (FAERS) database were retrieved for disproportionality and Bayesian analysis. Reporting odds ratios (ROR) and information component (IC) were used to evaluate correlations between ICIs and hepatic failure.

Hepatic failure occurred in 0.19% (18,454/9,647,655) of all cases in the FAERS database, of which 654 cases were associated with ICIs. The overall median time from ICIs initiation to hepatic failure onset was 38 days, 72.3% of the adverse events occurred within the first 3 months, and 68.65% of the cases died after developing hepatic failure. In general, a strong signal was shown between ICIs and hepatic failure (ROR₀₂₅  = 2.70, IC₀₂₅  = 1.39). For the three categories of ICIs, programmed cell death 1 ligand 1 inhibitors (ROR₀₂₅  = 3.09, IC₀₂₅  = 1.57) had a higher risk signal than programmed cell death protein 1 inhibitors and cytotoxic T lymphocyte-associated protein 4 inhibitors. For monotherapy, atezolizumab showed the strongest risk signal (ROR₀₂₅  = 4.07, IC₀₂₅  = 1.90). The combination of nivolumab and ipilimumab showed stronger signals of hepatic failure compared with nivolumab or ipilimumab alone (nivolumab + ipilimumab vs. ipilimumab: ROR₀₂₅  = 1.40, IC₀₂₅  = 0.16; nivolumab + ipilimumab vs. nivolumab: ROR₀₂₅  = 1.24, IC₀₂₅  = 0.34). Considering the concomitant agents used with ICIs, the majority of these regimens showed stronger signals than ICI monotherapy, such as acetaminophen (ICIs + acetaminophen vs. ICIs: ROR₀₂₅  = 1.06, IC₀₂₅  = 0.32).

ICIs had possible strong signals associated with hepatic failure, and most cases of hepatic failure occurred within the first 3 months and had poor outcomes, which should attract clinical attention.