eprintid: 10086609 rev_number: 17 eprint_status: archive userid: 608 dir: disk0/10/08/66/09 datestamp: 2019-11-26 17:54:56 lastmod: 2021-09-23 22:39:42 status_changed: 2019-11-26 17:54:56 type: article metadata_visibility: show creators_name: Shivaji, UN creators_name: Jeffery, L creators_name: Gui, X creators_name: Smith, SCL creators_name: Ahmad, OF creators_name: Akbar, A creators_name: Ghosh, S creators_name: Iacucci, M title: Immune checkpoint inhibitor-associated gastrointestinal and hepatic adverse events and their management ispublished: pub subjects: UCH divisions: UCL divisions: B04 divisions: C05 divisions: F42 keywords: anti-CTLA-4, anti-PD1, anti-PDL1, immune checkpoint inhibitors, immune-related hepatitis, immune-related colitis, management note: © 2019 by SAGE Publications Ltd. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/). abstract: BACKGROUND: Drug-induced colitis is a known complication of therapies that alter the immune balance, damage the intestinal barrier or disturb intestinal microbiota. Immune checkpoint inhibitors (ICI) directed against cancer cells may result in activated T lymphocyte-induced immune-related adverse events (AEs), including immune-related colitis and hepatitis. The aim of this review article is to summarize the incidence of gastrointestinal (GI) and hepatic AEs related to ICI therapy. We have also looked at the pathogenesis of immune-mediated AEs and propose management strategies based on current available evidence. METHODS: A literature search using PubMed and Medline databases was undertaken using relevant search terms pertaining to names of individual drugs, mechanism of action, related AEs and their management. RESULTS: ICI-related GI AEs are common, and colitis appears to be the most common side effect, with some studies reporting incidence as high as 30%. The incidence of both all-grade colitis and hepatitis were highest with combination therapy with anti-CTLA-4/PD-1; severity of colitis was dose-dependent (anti-CTLA-4). Early intervention is associated with better outcomes. CONCLUSION: ICI-related GI and hepatic AEs are common and clinicians need to be aware. Patients with GI AEs benefit from early diagnosis using endoscopy and computed tomography. Early intervention with oral steroids is effective in the majority of patients, and in steroid-refractory colitis infliximab and vedolizumab have been reported to be useful; mycophenolate has been used for steroid-refractory hepatitis. date: 2019-01 date_type: published official_url: https://doi.org/10.1177%2F1756284819884196 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1720886 doi: 10.1177/1756284819884196 lyricists_name: Ahmad, Omer lyricists_id: OFAHM68 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: Therapeutic Advances in Gastroenterology volume: 12 pagerange: 1-15 issn: 1756-2848 citation: Shivaji, UN; Jeffery, L; Gui, X; Smith, SCL; Ahmad, OF; Akbar, A; Ghosh, S; Shivaji, UN; Jeffery, L; Gui, X; Smith, SCL; Ahmad, OF; Akbar, A; Ghosh, S; Iacucci, M; - view fewer <#> (2019) Immune checkpoint inhibitor-associated gastrointestinal and hepatic adverse events and their management. Therapeutic Advances in Gastroenterology , 12 pp. 1-15. 10.1177/1756284819884196 <https://doi.org/10.1177/1756284819884196>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10086609/1/1756284819884196.pdf