Corticosteroid Therapy for Drug-induced Liver Injury: Mind the Gap!

Area of Science:

• Hepatology
• Clinical Pharmacology
• Oncology

Background:

• Idiosyncratic drug-induced liver injury (DILI) affects 80% of individuals, with potential for chronic injury, liver failure, or death.
• Corticosteroids are used for DILI due to anti-inflammatory properties, but evidence for hastening resolution or preventing adverse outcomes is lacking.
• Checkpoint inhibitor-induced liver injury (ChILI) is a growing concern in cancer treatment, with corticosteroids often used liberally.

Purpose of the Study:

• To evaluate the efficacy and safety of corticosteroids in managing DILI and ChILI.
• To assess the impact of corticosteroids on liver injury resolution, progression, and patient survival.
• To explore alternative, corticosteroid-sparing approaches for ChILI.

Main Methods:

• Review of existing literature on DILI and ChILI management.
• Analysis of corticosteroid use in DILI and ChILI, including high-dose and long-term applications.
• Evaluation of corticosteroid-sparing strategies and their outcomes.

Main Results:

• Corticosteroids do not accelerate resolution of acute DILI or prevent mortality/transplantation.
• High-dose, long-term corticosteroid use in ChILI can impair liver repair, delay resolution, and increase adverse effects.
• Corticosteroid use within 2 months of checkpoint inhibitors is linked to reduced overall survival.
• Corticosteroid-sparing approaches are safe and effective for most ChILI patients.

Conclusions:

• Corticosteroids are not proven to benefit acute DILI and may harm ChILI patients.
• High-dose corticosteroids can negatively impact liver regeneration and survival in ChILI.
• Selective, short-term prednisolone use may be considered in specific ChILI cases after excluding cholestasis.