Expert Clinical Management of Severe Immune-Related Adverse Events: Results from a Multicenter Survey on Hot Topics for Management
There are differences in recommendations for the management of immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs). To assess the real-world management of irAEs, three surveys regarding ICI-induced hepatitis (IIH), renal irAEs, and myositis were developed and se...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/20/5977 |
| _version_ | 1797431469275086848 |
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| author | Mar Riveiro-Barciela Maria Jose Soler Ana Barreira-Diaz Sheila Bermejo Sebastian Bruera Maria E. Suarez-Almazor |
| author_facet | Mar Riveiro-Barciela Maria Jose Soler Ana Barreira-Diaz Sheila Bermejo Sebastian Bruera Maria E. Suarez-Almazor |
| author_sort | Mar Riveiro-Barciela |
| collection | DOAJ |
| description | There are differences in recommendations for the management of immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs). To assess the real-world management of irAEs, three surveys regarding ICI-induced hepatitis (IIH), renal irAEs, and myositis were developed and sent to experts in each area. Fifty-six surveys were completed (17 IIH, 20 renal irAEs, and 19 myositis). All experts agreed on performing imaging in every suspected case of severe IIH. Sixty-five percent agreed on performing a liver biopsy in patients not responding to corticosteroids. The most common indication for corticosteroid use (59%) was for severe IIH not improving after discontinuation of ICIs. Additionally, 60% of the experts agreed on performing a biopsy for stage 2/3 acute kidney injury (AKI), and 70% recommended imaging for any stage of AKI. Thirty-five percent favored corticosteroids in AKI patients with creatinine levels 2–3-fold above baseline. For myositis, 58% would recommend a muscle biopsy in a patient with weakness and creatine kinase levels of 5000 U/L; 47% would also opt for an endomyocardial biopsy when the troponin levels are increased. Fifty-eight percent recommended oral corticosteroids for myositis, and 37% recommended additional therapy, mainly immunoglobulins. These results show substantial differences in expert practice patterns for the management of severe liver, kidney, and muscular irAEs. |
| first_indexed | 2024-03-09T09:45:32Z |
| format | Article |
| id | doaj.art-2a2586b99eee42f3b1156c64b00060c2 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T09:45:32Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-2a2586b99eee42f3b1156c64b00060c22023-12-02T00:33:29ZengMDPI AGJournal of Clinical Medicine2077-03832022-10-011120597710.3390/jcm11205977Expert Clinical Management of Severe Immune-Related Adverse Events: Results from a Multicenter Survey on Hot Topics for ManagementMar Riveiro-Barciela0Maria Jose Soler1Ana Barreira-Diaz2Sheila Bermejo3Sebastian Bruera4Maria E. Suarez-Almazor5Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, SpainDepartment of Medicine, Autonomous Univeristy of Barcelona (AUB), 08035 Barcelona, SpainLiver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, SpainDepartment of Medicine, Autonomous Univeristy of Barcelona (AUB), 08035 Barcelona, SpainSection of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, TX 77030, USADepartment of Health Services Research and Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USAThere are differences in recommendations for the management of immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs). To assess the real-world management of irAEs, three surveys regarding ICI-induced hepatitis (IIH), renal irAEs, and myositis were developed and sent to experts in each area. Fifty-six surveys were completed (17 IIH, 20 renal irAEs, and 19 myositis). All experts agreed on performing imaging in every suspected case of severe IIH. Sixty-five percent agreed on performing a liver biopsy in patients not responding to corticosteroids. The most common indication for corticosteroid use (59%) was for severe IIH not improving after discontinuation of ICIs. Additionally, 60% of the experts agreed on performing a biopsy for stage 2/3 acute kidney injury (AKI), and 70% recommended imaging for any stage of AKI. Thirty-five percent favored corticosteroids in AKI patients with creatinine levels 2–3-fold above baseline. For myositis, 58% would recommend a muscle biopsy in a patient with weakness and creatine kinase levels of 5000 U/L; 47% would also opt for an endomyocardial biopsy when the troponin levels are increased. Fifty-eight percent recommended oral corticosteroids for myositis, and 37% recommended additional therapy, mainly immunoglobulins. These results show substantial differences in expert practice patterns for the management of severe liver, kidney, and muscular irAEs.https://www.mdpi.com/2077-0383/11/20/5977immune checkpoint inhibitorsimmunotherapyimmune-related hepatitisacute kidney injurymyositismyocarditis |
| spellingShingle | Mar Riveiro-Barciela Maria Jose Soler Ana Barreira-Diaz Sheila Bermejo Sebastian Bruera Maria E. Suarez-Almazor Expert Clinical Management of Severe Immune-Related Adverse Events: Results from a Multicenter Survey on Hot Topics for Management Journal of Clinical Medicine immune checkpoint inhibitors immunotherapy immune-related hepatitis acute kidney injury myositis myocarditis |
| title | Expert Clinical Management of Severe Immune-Related Adverse Events: Results from a Multicenter Survey on Hot Topics for Management |
| title_full | Expert Clinical Management of Severe Immune-Related Adverse Events: Results from a Multicenter Survey on Hot Topics for Management |
| title_fullStr | Expert Clinical Management of Severe Immune-Related Adverse Events: Results from a Multicenter Survey on Hot Topics for Management |
| title_full_unstemmed | Expert Clinical Management of Severe Immune-Related Adverse Events: Results from a Multicenter Survey on Hot Topics for Management |
| title_short | Expert Clinical Management of Severe Immune-Related Adverse Events: Results from a Multicenter Survey on Hot Topics for Management |
| title_sort | expert clinical management of severe immune related adverse events results from a multicenter survey on hot topics for management |
| topic | immune checkpoint inhibitors immunotherapy immune-related hepatitis acute kidney injury myositis myocarditis |
| url | https://www.mdpi.com/2077-0383/11/20/5977 |
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