Drug-Induced liver injury with adebrelimab: how to assess causality using the updated RUCAM?

Area of Science:

• Oncology
• Hepatology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) like Adebrelimab are vital in cancer therapy.
• Hepatotoxicity is a known adverse effect of ICIs.
• Accurate diagnosis of ICI-induced liver injury is critical for patient management.

Purpose of the Study:

• To report a case of Adebrelimab-related liver injury.
• To emphasize the utility of the updated Roussel Uclaf Causality Assessment Method (RUCAM) in assessing ICI-induced hepatotoxicity.
• To guide clinical management of similar cases.

Main Methods:

• Case report of a 51-year-old male with small-cell lung cancer.
• Utilized the updated RUCAM for causality assessment of liver injury.
• Compared RUCAM score with simplified autoimmune hepatitis (AIH) score.
• Monitored liver function tests and clinical symptoms.

Main Results:

• The patient developed severe jaundice after Adebrelimab therapy.
• The updated RUCAM score was 8, indicating a highly probable drug-induced liver injury.
• Simplified AIH score ruled out autoimmune hepatitis.
• Liver enzymes and bilirubin normalized with methylprednisolone treatment.

Conclusions:

• The updated RUCAM is valuable for distinguishing drug-induced liver injury from other causes in ICI recipients.
• Accurate causality assessment guides appropriate clinical management.
• Early recognition and treatment of ICI-induced hepatotoxicity improve patient outcomes.