Balancing act: Tapering mycophenolate mofetil in immune checkpoint inhibitor hepatitis-strategies, outcomes, and risks

Table 1 Comparing common prognostic indices for drug-induced liver injury, highlighting key differences in purpose, application, interpretation, and application

Metric	Purpose	Key parameters	Interpretation	Application
CTCAE (ICI hepatitis)	Grading severity for oncologic toxicity	ALT, AST, bilirubin, symptoms (e.g., jaundice)	Grade 1-5 (mild to death)-determines ICI holding/resuming, steroid initiation	Oncology (especially in immunotherapy)
MELD score	Predict liver-related mortality	Bilirubin, INR, Creatinine (± Na, albumin)	Numerical score → mortality prediction, transplant priority	Cirrhosis, acute liver failure, transplant prioritization
Hy’s law	Identify serious DILI risk	ALT or AST > 3 × ULN AND total bilirubin > 2 × ULN without obstruction	Signals risk of serious hepatotoxicity in idiosyncratic DILI. Predicts about 10% risk of death or transplant in DILI cases	Drug safety (clinical trials, post-market surveillance)
Modified Hy’s law	Improve prediction of DILI-related outcomes	Similar to Hy’s but may use ALP and stricter temporal linkage	More clinically specific/refined for assessing hepatotoxicity risk	Adaptation for real-world/Lab data

ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CTCAE: Common terminology criteria for adverse events; DILI: Drug-induced liver injury; INR: International normalized ratio; ICI: Immune checkpoint inhibitor; MELD: Model for end-stage liver disease; ULN: Upper limit of normal.