Autoimmune Hepatitis Induced by Immune Checkpoint Inhibitors in Adults: A Systematic Review.

Area of Science:

• Hepatology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but can cause immune-related adverse events, including liver injury.
• Some ICI-induced liver injuries mimic autoimmune hepatitis (AIH), termed AIH-like immune-mediated hepatitis, requiring careful management to balance cancer treatment and liver recovery.

Purpose of the Study:

• To systematically review the clinical characteristics, diagnosis, treatment, and outcomes of patients experiencing AIH-like liver injury due to ICIs.
• To summarize treatment strategies, response rates, and outcomes related to ICI discontinuation and rechallenge in this patient population.

Main Methods:

• A systematic PubMed search was conducted for English-language human studies on AIH or immune-mediated hepatitis following ICI exposure.
• Included studies were case reports, case series, and cohort studies, adhering to PRISMA principles.
• Data were descriptively synthesized due to heterogeneity in study designs and outcome reporting.

Main Results:

• Twenty-two studies involving 195 patients with ICI-associated AIH-like liver injury were analyzed.
• Corticosteroids were effective first-line treatment, achieving recovery in 102 of 105 patients; mycophenolate mofetil was effective for steroid-refractory cases (9/10 response).
• Most patients (133/140) recovered with treatment, and 55 patients were successfully rechallenged with ICIs without recurrent liver toxicity.

Conclusions:

• ICI-associated AIH-like liver injury is a significant immune-related toxicity, with most patients recovering, particularly with corticosteroid therapy.
• Mycophenolate mofetil is a key second-line treatment for refractory cases, but evidence quality is limited by study heterogeneity.
• Future research should standardize diagnostic criteria and outcome reporting to better differentiate AIH-like injury from classical AIH and guide management.