Real-World Adherence to Toxicity Management Guidelines for Immune-Related Adverse Events
Immune checkpoint inhibitors (ICIs) affect immunologic homeostasis, leading to immune-related adverse events (irAEs). Early irAE detection and management can prevent significant morbidity and mortality. A retrospective chart review was performed to characterize irAEs associated with nivolumab, ipili...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-04-01
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| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/29/5/252 |
| _version_ | 1827669475663544320 |
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| author | Arezou Teimouri Laura V. Minard Samantha N. Scott Amanda Daniels Stephanie Snow |
| author_facet | Arezou Teimouri Laura V. Minard Samantha N. Scott Amanda Daniels Stephanie Snow |
| author_sort | Arezou Teimouri |
| collection | DOAJ |
| description | Immune checkpoint inhibitors (ICIs) affect immunologic homeostasis, leading to immune-related adverse events (irAEs). Early irAE detection and management can prevent significant morbidity and mortality. A retrospective chart review was performed to characterize irAEs associated with nivolumab, ipilimumab, and nivolumab plus ipilimumab in adult medical oncology patients in Nova Scotia Health-Central Zone from 2013–2020, and to describe adherence to toxicity management guidelines. Diarrhea/colitis, hepatitis, pneumonitis, nephrotoxicity, and cardiotoxicity were studied. Of 129 charts reviewed, 67 patients (51.9%) experienced at least one irAE for a total of 98 irAEs and a 1.5% fatality rate. Of these irAEs, 33.7% led to an emergency room visit. Patients were admitted to hospital and steroids were used in 24.5% and 35.7% of cases, respectively. In 17.3% of irAEs, ICIs were permanently discontinued. In 20.4% of irAEs, ICIs were held, and patients were monitored; while in 18.4%, ICIs were held until the irAE was Grade 0–1 (and until steroids were tapered). Almost 47% of irAEs were managed according to guidelines (14.3% were not), and 38.8% had no documented management. Patients receiving immunotherapy frequently experience irAEs with half of irAEs having documented management adhering to guidelines. As immunotherapy indications expand, it is important to ensure irAEs are documented and managed appropriately. |
| first_indexed | 2024-03-10T03:03:44Z |
| format | Article |
| id | doaj.art-50f190c36f024eb39fcfc7a7daee2141 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-10T03:03:44Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-50f190c36f024eb39fcfc7a7daee21412023-11-23T10:36:46ZengMDPI AGCurrent Oncology1198-00521718-77292022-04-012953104311710.3390/curroncol29050252Real-World Adherence to Toxicity Management Guidelines for Immune-Related Adverse EventsArezou Teimouri0Laura V. Minard1Samantha N. Scott2Amanda Daniels3Stephanie Snow4Department of Pharmacy, Nova Scotia Health, QEII Health Sciences Centre, Halifax, NS B3H 3A7, CanadaDepartment of Pharmacy, Nova Scotia Health, QEII Health Sciences Centre, Halifax, NS B3H 3A7, CanadaDepartment of Pharmacy, Nova Scotia Health, QEII Health Sciences Centre, Halifax, NS B3H 3A7, CanadaDepartment of Pharmacy, Nova Scotia Health, QEII Health Sciences Centre, Halifax, NS B3H 3A7, CanadaQEII Health Sciences Centre, Division of Medical Oncology, Dalhousie University, Halifax, NS B3H 4R2, CanadaImmune checkpoint inhibitors (ICIs) affect immunologic homeostasis, leading to immune-related adverse events (irAEs). Early irAE detection and management can prevent significant morbidity and mortality. A retrospective chart review was performed to characterize irAEs associated with nivolumab, ipilimumab, and nivolumab plus ipilimumab in adult medical oncology patients in Nova Scotia Health-Central Zone from 2013–2020, and to describe adherence to toxicity management guidelines. Diarrhea/colitis, hepatitis, pneumonitis, nephrotoxicity, and cardiotoxicity were studied. Of 129 charts reviewed, 67 patients (51.9%) experienced at least one irAE for a total of 98 irAEs and a 1.5% fatality rate. Of these irAEs, 33.7% led to an emergency room visit. Patients were admitted to hospital and steroids were used in 24.5% and 35.7% of cases, respectively. In 17.3% of irAEs, ICIs were permanently discontinued. In 20.4% of irAEs, ICIs were held, and patients were monitored; while in 18.4%, ICIs were held until the irAE was Grade 0–1 (and until steroids were tapered). Almost 47% of irAEs were managed according to guidelines (14.3% were not), and 38.8% had no documented management. Patients receiving immunotherapy frequently experience irAEs with half of irAEs having documented management adhering to guidelines. As immunotherapy indications expand, it is important to ensure irAEs are documented and managed appropriately.https://www.mdpi.com/1718-7729/29/5/252immune-related adverse eventsimmune checkpoint inhibitorsquality assurancetoxicity guideline adherence |
| spellingShingle | Arezou Teimouri Laura V. Minard Samantha N. Scott Amanda Daniels Stephanie Snow Real-World Adherence to Toxicity Management Guidelines for Immune-Related Adverse Events Current Oncology immune-related adverse events immune checkpoint inhibitors quality assurance toxicity guideline adherence |
| title | Real-World Adherence to Toxicity Management Guidelines for Immune-Related Adverse Events |
| title_full | Real-World Adherence to Toxicity Management Guidelines for Immune-Related Adverse Events |
| title_fullStr | Real-World Adherence to Toxicity Management Guidelines for Immune-Related Adverse Events |
| title_full_unstemmed | Real-World Adherence to Toxicity Management Guidelines for Immune-Related Adverse Events |
| title_short | Real-World Adherence to Toxicity Management Guidelines for Immune-Related Adverse Events |
| title_sort | real world adherence to toxicity management guidelines for immune related adverse events |
| topic | immune-related adverse events immune checkpoint inhibitors quality assurance toxicity guideline adherence |
| url | https://www.mdpi.com/1718-7729/29/5/252 |
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