Skip to main content
. 2024 Jun 5;23(1):e0191. doi: 10.1097/CLD.0000000000000191

FIGURE 1.

FIGURE 1

Treatment algorithm for immune-mediated liver injury from checkpoint inhibitors. The management of ILICI depends on its severity at presentation. In nonresolving or worsening Grade 1 or Grade 2/3 patients, evaluation for alternative causes, including a contrast-enhanced CT or MRI is recommended while withholding the ICI as well as oral prednisone with frequent lab checks. Approximately 20%–30% of Grade 2–4 patients will not improve with high-dose oral or i.v. corticosteroids, wherein a liver biopsy is recommended to confirm the diagnosis and exclude alternative causes. Oral mycophenolate mofetil leads to laboratory normalization in 80% of steroid nonresponders, allowing steroids to be safely tapered over 6–10 weeks. For mycophenolate nonresponders, a liver biopsy is recommended if not previously done before considering further immunosuppression. Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; CT, Computerized tomography; ICI, immune checkpoint inhibitor; ILICI, immune-mediated liver injury from checkpoint inhibitor; LFT, liver biochemistries; ULN, upper limit of normal.