{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T15:58:01Z","timestamp":1773763081935,"version":"3.50.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"1206","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Manchester Academic Health Science Centre"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immune-mediated hepatitis is a common toxicity and accounts for \u205320% of immune checkpoint inhibitor (ICI) related deaths. There is broad consensus as to the current approach for acute management for immune-mediated hepatitis. There is little data regarding the duration of immunosuppression in severe immune-mediated hepatitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective observational analysis was performed at a specialist oncology hospital in England from 20th May 2018 to 19th April 2024. The need for second-line immunosuppression, the agents used and their duration were analyzed. The primary outcome was duration of second-line immunosuppression and whether there was a relapse in immune-mediated hepatitis following their cessation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the study period, 82 patients presented with grade\u2009\u22653 immune-mediated hepatitis. Thirty-five (42.7%) had grade 3 hepatitis with 47 (57.3%) having grade 4 hepatitis. All patients received corticosteroids as first line treatment. Twenty-six (31.7%) patients required second-line immunosuppression therapy with mycophenolate mofetil. Four of those required further immunosuppression with a calcineurin inhibitor. The cohort requiring second-line immunosuppression had higher transaminases (mean alanine aminotransferase (ALT) =\u2009889 u\/L vs 677 u\/L) at presentation. The median duration of therapy was 3\u00a0months (6\u00a0weeks to 22\u00a0months); all patients except for one had stopped their immunosuppression at 6\u00a0months. Ten patients who initially received combination ICI therapy had a rechallenge with maintenance nivolumab without a relapse of their hepatitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most patients with ICI-mediated hepatitis respond to first line immune suppression but approximately one third require second line therapy. Most patients discontinued immune suppression within 3\u00a0months.<\/jats:p>\n                    <jats:p>Key messages What is already known on this topic: Hepatitis is a common complication of immune checkpoint inhibition often requiring treatment with steroids and immunosuppression. What this study adds: This prospective observational study of patients presenting with severe ICI induced hepatitis found 26 (31.7%) patients required second-line immunosuppression therapy with a further four requiring third-line agents. The median duration of therapy was 3\u00a0months. How this study might affect practice: Most patients with ICI induced hepatitis respond to first line immune suppression but approximately one third require second line therapy, which can often be stopped 3\u00a0months post initiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/postmj\/qgaf167","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T11:53:37Z","timestamp":1757678017000},"page":"320-323","source":"Crossref","is-referenced-by-count":0,"title":["Immune-mediated hepatitis requiring second-line immunosuppression: how long is required? An observational study"],"prefix":"10.1093","volume":"102","author":[{"given":"Tim","family":"Cooksley","sequence":"first","affiliation":[{"name":"Departments of Acute Oncology and Medical Oncology , The Christie, Wilmslow Road, Manchester, Lancashire, M20 4BX ,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie M J","family":"Weaver","sequence":"additional","affiliation":[{"name":"Departments of Acute Oncology and Medical Oncology , The Christie, Wilmslow Road, Manchester, Lancashire, M20 4BX ,","place":["United Kingdom"]},{"name":"Faculty of Biology, Medicine and Healthcare, University of Manchester , Moss Ln E, Manchester M14 4PX ,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Safwaan","family":"Adam","sequence":"additional","affiliation":[{"name":"Departments of Acute Oncology and Medical Oncology , The Christie, Wilmslow Road, Manchester, Lancashire, M20 4BX ,","place":["United 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