{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:31:53Z","timestamp":1791185513444,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,3,16]],"date-time":"2015-03-16T00:00:00Z","timestamp":1426464000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Simon Kerr Memorial Fellowship"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2015,4]]},"abstract":"Abstract<\/jats:title>\n \n I<\/jats:styled-content>\n pilimumab has been shown to improve overall survival in patients with advanced melanoma.\n I<\/jats:styled-content>\n pilimumab acts through immune\u2010modulation, and is recognized to cause potentially severe immune\u2010related adverse events (\n irAEs<\/jats:styled-content>\n ) including dermatitis, colitis, thyroiditis, hypophysitis, and hepatitis. The acceptance of ipilimumab as a treatment for metastatic melanoma means patients will continue to be treated with this agent and gastroenterologists will be increasingly called upon to assist in managing severe autoimmune\u2010related hepatitis and colitis. To date, the recommendations for managing\n irAEs<\/jats:styled-content>\n secondary to\n ipilimumab<\/jats:styled-content>\n have been steroids at a moderate dose of prednisolone (1\u2009mg\/kg) as well as immunosuppressive agents such as mycophenolate mofetil (\n MMF<\/jats:styled-content>\n ) for steroid\u2010refractory hepatitis and infliximab in the management of corticosteroid\u2010refractory colitis. However, the dosing and the duration of immunosuppressive therapy have not been systematically studied in the setting of treating ipilimumab\u2010induced\n irAEs<\/jats:styled-content>\n . Therefore, additional immune\u2010modifying agents and\/or a change in dosing may be required to manage severe\n irAEs<\/jats:styled-content>\n unresponsive to existing treatment recommendations. We describe a treatment paradigm illustrated by a series of five patients who experienced\n irAEs<\/jats:styled-content>\n . In three cases of metastatic melanoma, ipilimumab\u2010induced hepatitis was successfully treated with high\u2010dose parenteral pulsed methylprednisolone. In two other melanoma patients with ipilimumab\u2010induced colitis, one patient had satisfactory resolution of his colitis with high\u2010dose corticosteroid therapy alone and the other patient required infliximab infusion. We have reviewed the current literature and management algorithms for ipilimumab\u2010induced\n irAEs<\/jats:styled-content>\n . Treatment options and the rationale for their use are discussed, including the use of pulsed high\u2010dose steroids,\n MMF<\/jats:styled-content>\n , azathioprine and calcineurin inhibitors.\n <\/jats:p>","DOI":"10.1111\/jgh.12888","type":"journal-article","created":{"date-parts":[[2015,1,16]],"date-time":"2015-01-16T11:59:02Z","timestamp":1421409542000},"page":"657-666","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["Ipilimumab\u2010induced toxicities and the gastroenterologist"],"prefix":"10.1111","volume":"30","author":[{"given":"Robert","family":"Cheng","sequence":"first","affiliation":[{"name":"A.W. Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Cooper","sequence":"additional","affiliation":[{"name":"Royal Prince Alfred Hospital Camperdown New South Wales Australia"},{"name":"Chris O'Brien Lifehouse Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Kench","sequence":"additional","affiliation":[{"name":"Department of Tissue Pathology and Diagnostic Oncology Royal Prince Alfred Hospital Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoff","family":"Watson","sequence":"additional","affiliation":[{"name":"Department of Tissue Pathology and Diagnostic Oncology Royal Prince Alfred Hospital Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Bye","sequence":"additional","affiliation":[{"name":"A.W. 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