Diagnostic and therapeutic recommendations for steroid-resistant hepatitis
| Guidelines | ||||
| ESMO (2022)1 | ASCO (2021)3 | SITC (2021)2 | NCCN (2023)40 | |
| Diagnostic procedures | ||||
| Repetition of initial workup | ✓ | ✓ | ||
| Rule out cytomegalovirus infection | ✓ | ✓ | ||
| Consultation with a hepatologist | ✓ | ✓ | ✓ | ✓ |
| Liver biopsy | ✓ | ✓ | ✓ | ✓ |
| Referral to tertiary center | ✓ | |||
| Treatment options (1) First choice of additional immunosuppressive treatment. (2) Other options of immunosuppressive treatment. (*) No treatment sequence mentioned. | ||||
| Increase of steroid dose to 1–2 mg/kg/day in grade II | ✓(*) | |||
| Change to intravenous administration of steroid treatment | ✓(*) | |||
| Mycophenolate mofetil (peroral) | ✓(*) | ✓(*) | ✓(*) | ✓(1) |
| Tocilizumab (intravenous) | ✓(*) | |||
| Azathioprine (peroral) | ✓(*) | ✓(*) | ✓(2) | |
| Tacrolimus (peroral) | ✓(*) | ✓(2) | ✓(2) | |
| Anti-thymocyte globulin (intravenous) | ✓(*) | ✓(2) | ✓(2) | |
| Ciclosporin (peroral) | ✓(*) | ✓(2) | ||
| Do not use infliximab | ✓(x) | ✓ | ✓ | ✓ |
ASCO, American Society of Clinical Oncology; ESMO, European Society for Medical Oncology; NCCN, National Comprehensive Cancer Network; SITC, Society for Immunotherapy of Cancer.