Table 3.
Summary of studies of ICI-related GI and liver complications refractory to steroids.
| Therapy for ICI-related colitis | Study | Dosages used | Results |
|---|---|---|---|
| Infliximab | Johnson et al.45
Compared infliximab versus corticosteroids (75 patients, 48% received infliximab) |
1–3 infusions of infliximab | • Infliximab + steroids superior to steroids
alone • Resolution of diarrhoea 3 days versus 9 days (median) • Duration of steroid use shorter at 35 days versus 51 days (median) |
| Pagès et al.44
(case report of one patient) |
Infliximab (5 mg/kg) single dose | • Symptom resolution in 2 days • Mucosal healing on endoscopy noted on day 7 |
|
| Vedolizumab | Hsieh et al.46
(case report of one patient) |
Standard induction dose (300 mg at 0, 2 and 6 weeks) | • Resolution of symptoms in 6 weeks • Successfully weaned off steroids • Mucosal healing on endoscopy by 6 weeks |
| Abu-Sbeih et al.47
(28 patients) |
3 infusions of vedolizumab | • Duration for improvement in symptoms after vedolizumab was
5 days (median) • Sustained clinical remission in 84% of patients |
|
| Faecal microbial transplant | Wang et al.48
(case report of two patients) |
FMT delivered via colonoscopy (50 g/250 ml) of liquid donor stool | • Clinical improvement with one patient but patient died
after 3 months due to primary malignancy • Sustained remission after 7 months of treatment with second patient |
| Therapy for ICI-related hepatic complications | |||
| Mycophenolate mofetil | Tanaka et al.49
(case report of one patient) |
2 g/day in addition to steroids (2 g for about 6 weeks and then tapered down and stopped in 2 weeks) | • Improvement in both AST and ALT with no recurrence after stopping MMF therapy |
| Anti-thymocyte globulin | Chmiel et al.50
(case report of one patient) |
1.5 mg/kg over 2 consecutive days followed by 2 doses over next 2 weeks | • Reduction in transaminases within 24 h and was sustained |
| Toclizumab | Stroud et al.51
(39 patients received toclizumab but included other indications) |
4 mg/kg infusion over 1 h Multiple infusions as per clinician decision |
• Clinical improvement reported in 79% of patients but no specific data on hepatitis only |
ICI, immune checkpoint inhibitors; GI, gastrointestinal; MMF, Mycophenolate mofetil.