Hepatotoxicity Induced by Biological Agents: Clinical Features and Current Controversies

作     者：Nelia Hernandez Fernando Bessone Nelia Hernandez;Fernando Bessone

作者机构：Hospital de ClinicasUniversidad de la RepublicaMontevideoUruguay Hospital Provincial del CentenarioUniversity of Rosario School of MedicineRosarioArgentina 

出 版 物：《Journal of Clinical and Translational Hepatology》 (临床与转化肝病杂志（英文版）)

年 卷 期：2022年第10卷第3期

页      面：486-495页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Hepatotoxicity Checkpoint inhibitors Biologics Autoimmune hepatitis Drug-induced liver injury 

摘      要：Novel biological agents including cytokines and recombinant fusion proteins are increasingly prescribed for cancer,rheumatologic,autoimmune,and inflammatory diseases,and are currently being evaluated in hepatocellular carcinoma(HCC).They are classified by their mechanism of action and include tumor necrosis factor-alpha(TNF-α)antagonists,T cell mediated antitumor inhibitors,interleukin receptor antagonists,and immune checkpoint inhibitors(ICIs).Some ICIs cause frequent hepatotoxicity with a variable clinical,biochemical,and serological presentation,especially in patients receiving another immunomodulatory *** of the cases of liver damage induced by biological agents spontaneously regress after drug withdrawal,but the others require steroid ***,there are no widely accepted recommendation for the use of corticosteroids in these patients,even though international cancer societies have their own *** drug-induced autoimmune hepatitis(DIAIH)from classic AIH is challenging for pathologists,but liver biopsy is valuable,particularly in cases with unclear clinical ***,novel histological patterns have been described in liver damage induced by these agents(i.e.,endothelitis,ring granuloma and secundary sclerosing cholangitis associated with lymphocytic infiltration of cytotoxic CD8+T cells).Here,we describe the clinical and biochemical characteristics of patients with hepatotoxicity induced by TNF-αantagonists and *** issues involved in the administration of corticosteroid therapy,and hepatitis B virus(HBV)reactivation induced by immunosuppressive therapy are also discussed.