This review evaluates the evidence for corticosteroid therapy in idiosyncratic drug-induced liver injury (DILI) and checkpoint inhibitor-induced liver injury (ChILI), examining outcomes including resolution of liver injury, death, liver transplantation, and overall survival.
Corticosteroids show no evidence of hastening resolution, preventing death, or averting liver transplantation in acute DILI; in ChILI, high-dose prolonged corticosteroids are associated with delayed resolution and increased adverse effects, and when used within 2 months of checkpoint inhibitor initiation, have been linked to reduced overall survival.
This is a narrative review without systematic meta-analysis; the underlying evidence base for ChILI management is largely observational; causality between corticosteroid use and reduced survival cannot be firmly established from the cited data.
Avoid routine or high-dose corticosteroids for acute DILI or ChILI — corticosteroid-sparing approaches are safe and effective in most ChILI patients. If corticosteroids are used in ChILI, limit to a modest prednisolone dose tapered over 4 weeks, reserved for progressive hyperbilirubinemia with marked necroinflammation on histology and after excluding cholestasis or cholangiopathy.
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