title: Risk of elevated transaminases in cancer patients treated with immune checkpoint inhibitors: a meta-analysis.
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.
authors.affiliation: a 1 Ain Shams University, Clinical Oncology Department , Cairo, Egypt +33028656 ; omar.abdelrhman@med.asu.edu.eg.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdel-Rahman
authors.affiliation: a 1 Ain Shams University, Clinical Oncology Department , Cairo, Egypt +33028656 ; omar.abdelrhman@med.asu.edu.eg.
authors.forename: Hesham
authors.initials: H
authors.lastname: ElHalawani
authors.affiliation: b 2 Ain Shams University, Medical Microbiology and Immunology Department , Cairo, Egypt.
authors.forename: Mona
authors.initials: M
authors.lastname: Fouad
mesh_terms: D000410:Alanine Transaminase / Q000378:metabolism*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000378:metabolism*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D012306:Risk
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: alanine aminotransferase; aspartate aminotransferase; ipilimumab; nivolumab; pembrolizumab