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Therefore, there is an urgent need to develop adapted guidelines to manage IRH.In the present letter, based on Ziogas <jats:italic>et al<\/jats:italic> report entitled \u2018When steroids are not enough in immune-related hepatitis: current clinical challenges discussed on the basis of a case report\u2019, several points are discussed: assessment of IRH severity and liver biopsy indication, immune-related cholangitis as a differential diagnosis for some IRH presentation, the need of steroids for IRH management or the indication for second line immunosuppressive treatment and finally, the possibility of immunotherapy resumption.<\/jats:p>","DOI":"10.1136\/jitc-2021-002337","type":"journal-article","created":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T23:10:26Z","timestamp":1616713826000},"page":"e002337","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["When steroids are not enough in immune-related hepatitis: current clinical challenges discussed on the basis of a case report"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3081-9810","authenticated-orcid":false,"given":"Marie-L\u00e9a","family":"Gauci","sequence":"first","affiliation":[{"name":"U976, INSERM, Paris, \u00cele-de-France, France"},{"name":"Universit\u00e9 Paris Diderot-Paris VII, Universit\u00e9 Sorbonne Paris Cit\u00e9, Paris, \u00cele-de-France, France"},{"name":"AP-HP, D\u00e9partement de Dermatologie, H\u00f4pital Saint-Louis, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barouyr","family":"Baroudjian","sequence":"additional","affiliation":[{"name":"AP-HP, D\u00e9partement de Dermatologie, H\u00f4pital Saint-Louis, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste","family":"Lebbe","sequence":"additional","affiliation":[{"name":"U976, INSERM, Paris, \u00cele-de-France, France"},{"name":"Universit\u00e9 Paris Diderot-Paris VII, Universit\u00e9 Sorbonne Paris Cit\u00e9, Paris, \u00cele-de-France, France"},{"name":"AP-HP, D\u00e9partement de Dermatologie, H\u00f4pital Saint-Louis, Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Roux","sequence":"additional","affiliation":[{"name":"Service d'h\u00e9patologie et r\u00e9animation h\u00e9patique, DMU DIGEST, AP-HP Nord, H\u00f4pital Beaujon, Clichy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"key":"2025100311532000000_9.3.e002337.1","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2020-001322"},{"key":"2025100311532000000_9.3.e002337.2","article-title":"Severe immune-related hepatitis induced by immune checkpoint inhibitors: clinical features and management proposal","author":"Gauci","year":"2020","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"2025100311532000000_9.3.e002337.3","doi-asserted-by":"crossref","DOI":"10.1016\/j.jhepr.2020.100170","article-title":"Liver toxicity as a limiting factor to the increasing use of immune checkpoint inhibitors","volume":"2","author":"De Martin","year":"2020","journal-title":"JHEP Rep"},{"key":"2025100311532000000_9.3.e002337.4","doi-asserted-by":"crossref","unstructured":"Cohen J , Dougan M , Zubiri L . 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