Magnesium Isoglycyrrhizinate Combined With Steroid Is Superior to Steroid Monotherapy in Checkpoint Inhibitor‐Induced Liver Injury

Background and Aims Steroids are the standard treatment for checkpoint inhibitor‐induced liver injury (ChILI). However, concerns about their adverse effects and impacts on long‐term outcomes highlight the need for alternative therapies. This study aims to evaluate the effectiveness of magnesium isoglycyrrhizinate (MgIG) in combination with steroids in ChILI. Methods A multicentre, retrospective, propensity score matched case–control study was conducted based on electronic medical records in patients with ChILI from December 2019 to December 2022 in five tertiary hospitals. Cases were categorised into combination therapy group and steroid monotherapy group. Results A total of 229 cases were included, with 114 in the combination therapy group and 115 in the steroid group. The reduction in ALT on day 10 was significantly greater in the combination group (−148 [−232 to −44] vs. −98 [−239 to 8], p = 0.01). Combination therapy was more likely to achieve ALT normalisation (OR 2.13, 95% CI 1.11–4.09, p = 0.023), and a greater proportion of patients with ≤ grade 1 liver injury (43.9% vs. 24.4%, p = 0.002) on day 10. Notably, MgIG reduced the steroid dose ( p = 0.023) and the proportion of patients requiring high‐dose steroids in patients with high‐grade liver injury (1.1% vs. 9.0%, p = 0.017). Length of stay was shorter in the combination group (15 [10–24] vs. 17 [13–28], p = 0.020). Conclusion Combination of MgIG and steroid outperformed steroid monotherapy by accelerating recovery, reducing the dose of steroids, and shortening length of stay in patients with ChILI.