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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Dec 5, 2025; 16(4): 109485
Published online Dec 5, 2025. doi: 10.4292/wjgpt.v16.i4.109485
Published online Dec 5, 2025. doi: 10.4292/wjgpt.v16.i4.109485
Balancing act: Tapering mycophenolate mofetil in immune checkpoint inhibitor hepatitis-strategies, outcomes, and risks
Sahaj Mujumdar, Sofia Shaikh, Anuroop Yekula, Daniel R Weinberg, Sarah B McPherson, Mark Levstik, Patrick Twohig, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14682, United States
Shu-Yen Chan, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232
Nida S Ansari, Internal Medicine, St. Joseph’s University Medical Center, Paterson, NJ 07504, United States
David Jerez Diaz, Internal Medicine, Florida State University, Sarasota Memorial Hospital, Sarasota, FL 34239, United States
Andrew M Moon, Department of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC 27713, United States
Author contributions: Mujumdar S, Shaikh SD, Yekula A, Weinberg DR, McPherson SB, Chen SY, Ansari NS, Jerez Diaz D, Levstik M, Moon AM, and Twohig P contributed equally to this work; Twohig P designed the overall concept and outline of the manuscript Mujumdar S, Shaikh SD, Yekula A, Weinberg DR, McPherson SB, Chen SY, Ansari NS, and Jerez Diaz D conducted the literature review and drafted the manuscript; Mujumdar S, Levstik M, Moon AM, and Twohig P made critical revisions; all authors prepared the draft and approved the submitted version.
Conflict-of-interest statement: Andrew M Moon is a consultant for TARGET RWE, Intercept Pharmaceuticals, IDEOlogy, Eisai, and Astra Zeneca, and receives research funding from the AASLD, ACG, NIH, Madrigal and DCN Diagnostic. All other authors report no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Patrick Twohig, MD, Assistant Professor, FRCPC, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14682, United States. patrick_twohig@urmc.rochester.edu
Received: May 13, 2025
Revised: June 7, 2025
Accepted: September 2, 2025
Published online: December 5, 2025
Processing time: 206 Days and 23.2 Hours
Revised: June 7, 2025
Accepted: September 2, 2025
Published online: December 5, 2025
Processing time: 206 Days and 23.2 Hours
Core Tip
Core Tip: This systematic review describes immune checkpoint inhibitor hepatitis (ICI) hepatitis and explores the different treatment strategies for this condition, with a focus on the data behind one of the second line agents used for treatment, mycophenolate mofetil (MMF). We review the evidence behind use of MMF for ICI hepatitis, including pathophysiology, clinical outcomes, risk of relapse, tapering strategies, and challenges with restarting immunotherapy in these patients. Future directions and unmet needs within this evolving field are also briefly discussed.