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Expert Opin Drug Saf. 2015 Oct;14(10):1507-18. doi: 10.1517/14740338.2015.1085969. Epub 2015 Sep 7.

Risk of elevated transaminases in cancer patients treated with immune checkpoint inhibitors: a meta-analysis.

Author information

1
a 1 Ain Shams University, Clinical Oncology Department , Cairo, Egypt +33028656 ; omar.abdelrhman@med.asu.edu.eg.
2
b 2 Ain Shams University, Medical Microbiology and Immunology Department , Cairo, Egypt.

Abstract

BACKGROUND:

This meta-analysis has been conducted to determine the risk of elevated transaminases associated with immune checkpoint inhibitors use in patients with cancer.

METHODS:

Studies eligible for our analysis included randomized Phase II and III trials of patients with cancer on ipilimumab, nivolumab, pembrolizumab, tremelimumab and pidilizumab, which describe events of elevated transaminases [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)].

RESULTS:

Initial database search revealed 210 relevant citations. After excluding noneligible studies, 10 trials were considered eligible for the quantitative synthesis. The RR of all-grade elevated ALT and AST was 2.36 (95% CI 1.20-4.66; p = 0.01) and 1.53 (95% CI 0.73-3.22; p = 0.26), respectively, whereas for high-grade elevated ALT and AST, it was 11.27 (95% CI 5.38-23.63; p < 0.0001) and 4.9 (95% CI 2.97-8.09; p < 0.0001), respectively.

CONCLUSIONS:

Our study has shown that the use of immune checkpoint inhibitors has a causal relationship to an increased risk of high-grade elevated ALT and AST. Clinicians using these agents should be attentive of this risk.

KEYWORDS:

alanine aminotransferase; aspartate aminotransferase; ipilimumab; nivolumab; pembrolizumab

PMID:
26394770
DOI:
10.1517/14740338.2015.1085969
[Indexed for MEDLINE]

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