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Clinical pharmacist participated in a case study of a severe immune-related cholestatic liver injury case induced by camrelizumab

Published on Feb. 28, 2025Total Views: 477 times Total Downloads: 38 times Download Mobile

Author: YUWEN Lixia HE Yunhao YUAN Yaohui

Affiliation: Department of Pharmacy, Central Hospital of Xingtai, Xingtai 054000, Hebei Province, China

Keywords: Clinical pharmacist Camrelizumab Liver injury Cholestatic Immunotherapy

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Abstract

One case of non-small cell lung adenocarcinoma patient developed severe liver injury (ALT 319.6 U·L-1, AST 103.3 U·L-1, ALP 586.8 U·L-1, DBIL 104.0 μmol·L-1, TBIL 172.3  μmol·L-1, IBIL 68.3 μmol·L-1), after multiple cycles of chemotherapy combined with camrelizumab. Subsequently, fever and jaundice on the face and sclera were noticed. Based on the previous medication, the RUCAM scale and the R value was used to evaluated the symptons, suggested a high likelihood of drug-induced cholestatic liver injury caused by camrelizumab. Clinical pharmacist proposed drug therapy recommendations for liver injury treatment and the selection of protective drugs. The physician adopted some of these therapeutic suggestions, and the patient was treated with methylprednisolone and hepatoprotective drugs. Although there was a temporary improvement in transaminase levels, bilirubin levels continued to rise. Later, the patient asked to discharge and passed away at home. Immune-related cholestatic liver injury caused by camrelizumab is insensitive to glucocorticoid therapy, clinicians should promptly consider adding immunosuppressants to enhance prognosis. Literature studies have shown that dual-molecule plasma adsorption system sequential plasma exchange has a certain therapeutic effect on immune-related cholestatic liver injury.

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References

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