irAE Hepatitis Grading (CTCAE)
CTCAE v5.0 grading of immune-related adverse event (irAE) hepatitis from checkpoint inhibitor immunotherapy. Guides management decisions including corticosteroid dosing and immunotherapy interruption.
Score interpretation
→ Grade 1 irAE hepatitis (ALT/AST 1–3x ULN): Continue immunotherapy; repeat LFTs weekly; no corticosteroids. Withhold if persistent Grade 1 with symptoms.
→ Grade 2 irAE hepatitis (ALT/AST 3–5x ULN): Withhold checkpoint inhibitor. Prednisolone 0.5–1 mg/kg/day; LFTs every 3 days; hepatology review; GI/rheumatology input; resume if improves to Grade 1.
→ Grade 3 irAE hepatitis (ALT/AST 5–20x ULN): Permanently discontinue checkpoint inhibitor. IV methylprednisolone 1–2 mg/kg/day; hospital admission; hepatology urgent review; if no improvement in 3 days — add mycophenolate mofetil 500 mg BD.
→ Grade 4 irAE hepatitis (ALT/AST >20x ULN): Permanently discontinue. ICU/liver unit admission. IV methylprednisolone 2 mg/kg/day; hepatology and transplant assessment; consider mycophenolate and/or anti-thymocyte globulin if refractory; monitor for acute liver failure.
Interpretation bands for the irAE Hepatitis. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Remdesivir · Antiviral — RNA Polymerase Inhibitor (COVID-19 / Hepatitis)
- Bulevirtide · Hepatitis D virus entry inhibitor
- Ipilimumab (Specialist drug) · Anti-CTLA-4 monoclonal antibody (immune checkpoint inhibitor)
- Nivolumab (Specialist drug) · Anti-PD-1 immune checkpoint inhibitor
- Pembrolizumab · Anti-PD-1 monoclonal antibody (immune checkpoint inhibitor)
- Atezolizumab · Anti-PD-L1 Monoclonal Antibody — Immune Checkpoint Inhibitor (Specialist Oncology Drug)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.