Impact of concomitant medications on the efficacy of immune checkpoint inhibitors: an umbrella review
IntroductionCancer is a major global health concern, and immune checkpoint inhibitors (ICIs) offer a promising treatment option for cancer patients. However, the efficacy of ICIs can be influenced by various factors, including the use of concomitant medications.MethodsWe searched databases (PubMed,...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1218386/full |
| _version_ | 1827804026328055808 |
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| author | Honglin Li Lei Zhang Feiran Yang Ruohan Zhao Xiurong Li Huijie Li |
| author_facet | Honglin Li Lei Zhang Feiran Yang Ruohan Zhao Xiurong Li Huijie Li |
| author_sort | Honglin Li |
| collection | DOAJ |
| description | IntroductionCancer is a major global health concern, and immune checkpoint inhibitors (ICIs) offer a promising treatment option for cancer patients. However, the efficacy of ICIs can be influenced by various factors, including the use of concomitant medications.MethodsWe searched databases (PubMed, Embase, Cochrane Library, Web of Science) for systematic reviews and meta-analyses for systematic reviews and meta-analyses on the impact of concomitant medications on ICIs efficacy, published from inception to January 1, 2023. We evaluated the methodological quality of the included meta-analyses, and re-synthesized data using a random-effects model and evidence stratification.ResultsWe included 23 publications, comprising 11 concomitant medications and 112 associations. Class II-IV evidence suggested that antibiotics have a negative impact on ICIs efficacy. However, ICIs efficacy against melanoma, hepatocellular carcinoma, and esophageal squamous cell carcinoma was not affected, this effect was related to the exposure window (class IV). Class III evidence suggested that proton pump inhibitors have a negative impact on ICIs efficacy; nevertheless, the efficacy against melanoma and renal cell carcinoma was not affected, and the effect was related to exposure before the initiation of ICIs therapy (class II). Although class II/III evidence suggested that steroids have a negative impact, this effect was not observed when used for non-cancer indications and immune-related adverse events (class IV). Class IV evidence suggested that opioids reduce ICIs efficacy, whereas statins and probiotics may improve ICIs efficacy. ICIs efficacy was not affected by histamine 2 receptor antagonists, aspirin, metformin, β-blockers, and nonsteroidal anti-inflammatory agents.ConclusionCurrent evidence suggests that the use of antibiotics, PPIs, steroids, and opioids has a negative impact on the efficacy of ICIs. However, this effect may vary depending on the type of tumor, the timing of exposure, and the intended application. Weak evidence suggests that statins and probiotics may enhance the efficacy of ICIs. Aspirin, metformin, β-blockers, and NSAIDs do not appear to affect the efficacy of ICIs. However, caution is advised in interpreting these results due to methodological limitations.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO,identifier, CRD42022328681. |
| first_indexed | 2024-03-11T21:03:48Z |
| format | Article |
| id | doaj.art-964816a470804df18fd231d22647e107 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-11T21:03:48Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-964816a470804df18fd231d22647e1072023-09-29T15:36:59ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-09-011410.3389/fimmu.2023.12183861218386Impact of concomitant medications on the efficacy of immune checkpoint inhibitors: an umbrella reviewHonglin Li0Lei Zhang1Feiran Yang2Ruohan Zhao3Xiurong Li4Huijie Li5First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, ChinaFirst Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, ChinaDepartment of Oncology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, ChinaDepartment of Oncology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, ChinaDepartment of Oncology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, ChinaDepartment of Oncology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, ChinaIntroductionCancer is a major global health concern, and immune checkpoint inhibitors (ICIs) offer a promising treatment option for cancer patients. However, the efficacy of ICIs can be influenced by various factors, including the use of concomitant medications.MethodsWe searched databases (PubMed, Embase, Cochrane Library, Web of Science) for systematic reviews and meta-analyses for systematic reviews and meta-analyses on the impact of concomitant medications on ICIs efficacy, published from inception to January 1, 2023. We evaluated the methodological quality of the included meta-analyses, and re-synthesized data using a random-effects model and evidence stratification.ResultsWe included 23 publications, comprising 11 concomitant medications and 112 associations. Class II-IV evidence suggested that antibiotics have a negative impact on ICIs efficacy. However, ICIs efficacy against melanoma, hepatocellular carcinoma, and esophageal squamous cell carcinoma was not affected, this effect was related to the exposure window (class IV). Class III evidence suggested that proton pump inhibitors have a negative impact on ICIs efficacy; nevertheless, the efficacy against melanoma and renal cell carcinoma was not affected, and the effect was related to exposure before the initiation of ICIs therapy (class II). Although class II/III evidence suggested that steroids have a negative impact, this effect was not observed when used for non-cancer indications and immune-related adverse events (class IV). Class IV evidence suggested that opioids reduce ICIs efficacy, whereas statins and probiotics may improve ICIs efficacy. ICIs efficacy was not affected by histamine 2 receptor antagonists, aspirin, metformin, β-blockers, and nonsteroidal anti-inflammatory agents.ConclusionCurrent evidence suggests that the use of antibiotics, PPIs, steroids, and opioids has a negative impact on the efficacy of ICIs. However, this effect may vary depending on the type of tumor, the timing of exposure, and the intended application. Weak evidence suggests that statins and probiotics may enhance the efficacy of ICIs. Aspirin, metformin, β-blockers, and NSAIDs do not appear to affect the efficacy of ICIs. However, caution is advised in interpreting these results due to methodological limitations.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO,identifier, CRD42022328681.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1218386/fullconcomitant medicationsimmune checkpoint inhibitorsefficacyumbrella reviewmeta-analysis |
| spellingShingle | Honglin Li Lei Zhang Feiran Yang Ruohan Zhao Xiurong Li Huijie Li Impact of concomitant medications on the efficacy of immune checkpoint inhibitors: an umbrella review Frontiers in Immunology concomitant medications immune checkpoint inhibitors efficacy umbrella review meta-analysis |
| title | Impact of concomitant medications on the efficacy of immune checkpoint inhibitors: an umbrella review |
| title_full | Impact of concomitant medications on the efficacy of immune checkpoint inhibitors: an umbrella review |
| title_fullStr | Impact of concomitant medications on the efficacy of immune checkpoint inhibitors: an umbrella review |
| title_full_unstemmed | Impact of concomitant medications on the efficacy of immune checkpoint inhibitors: an umbrella review |
| title_short | Impact of concomitant medications on the efficacy of immune checkpoint inhibitors: an umbrella review |
| title_sort | impact of concomitant medications on the efficacy of immune checkpoint inhibitors an umbrella review |
| topic | concomitant medications immune checkpoint inhibitors efficacy umbrella review meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1218386/full |
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