免疫相关性肝炎（irHepatitis）是检查点抑制剂相对常见的免疫相关不良事件（irAE）。通常，它对类固醇反应良好。然而，在难治性病例中，需要进一步治疗。抗肿瘤坏死因子 (TNF) 抗体可用于治疗多种 irAE，但有关 irHepatitis 的数据很少。在这里，我们报告了英夫利昔单抗治疗 10 例类固醇难治性肝炎的安全性和有效性。我们回顾性审查了苏黎世大学医院皮肤科接受英夫利昔单抗治疗的类固醇难治性 ≥3 级肝炎的患者。对英夫利昔单抗的阳性反应定义为丙氨酸氨基转移酶 (ALT)/天冬氨酸氨基转移酶 (AST) 比首次输注英夫利昔单抗时没有进一步增加 50% 以上，并且在没有类固醇和英夫利昔单抗以外的治疗的情况下控制了肝炎。 10 例使用类固醇的患者使用英夫利昔单抗 5mg/kg 治疗≥3 级的耐药性肝炎，其中 7 例（70%）出现阳性反应。在两个病例中，在肝炎得到控制之前，肝脏值增加了 50% 以上。在另一个病例中，给予了英夫利昔单抗和类固醇以外的治疗。中位随访时间为 487 天，90% 的患者在注射英夫利昔单抗后表现出 ir 肝炎得到缓解，且没有 AST/ALT 升高。用英夫利昔单抗治疗 ir 肝炎不会导致肝毒性，并且 10 例患者中有 9 例出现长期阳性反应。案件。需要进一步研究来评估抗 TNF 抗体在治疗肝炎中的作用。© 作者（或其雇主）2024。根据 CC BY-NC 允许重复使用。禁止商业再利用。请参阅权利和权限。由英国医学杂志出版。

Immune-related hepatitis (irHepatitis) is a relatively common immune-related adverse event (irAE) of checkpoint inhibitors. Often, it responds well to steroids; however, in refractory cases, further therapy is needed. Anti-tumor necrosis factor (TNF) antibodies are used for management of multiple irAEs, but there are little data in irHepatitis. Here, we report on safety and efficacy of infliximab in 10 cases of steroid-refractory irHepatitis.We retrospectively reviewed patients treated with infliximab for steroid-refractory grade ≥3 irHepatitis at the Department of Dermatology, University Hospital Zurich. The positive response to infliximab was defined as no further increase in alanine aminotransferase (ALT)/aspartate aminotransferase (AST) above 50% than at the time of first infliximab infusion and control of irHepatitis without therapies other than steroids and infliximab.10 patients with steroid-resistant irHepatitis grade ≥3 were treated with infliximab 5 mg/kg, of whom 7 (70%) responded positively. In two cases, the liver values increased over 50% before the irHepatitis could be controlled. In another case, therapies other than infliximab and steroids were given. At the median follow-up of 487 days, 90% of the patients demonstrated resolved irHepatitis without AST/ALT elevation following infliximab infusions.Treatment of irHepatitis with infliximab did not result in hepatotoxicity and led to long-lasting positive response in 9 of 10 of the cases. Further research is needed to evaluate the role of anti-TNF antibodies in management of irHepatitis.© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.