Clinical and immunological characteristics of PD-1 associated fulminant type 1 diabetes mellitus.
10.11817/j.issn.1672-7347.2023.220290
- Author:
Junlin QIU
1
,
2
,
3
;
Shuoming LUO
1
,
2
,
4
;
Wenfeng YIN
1
,
2
,
5
;
Xia LI
1
,
2
,
5
;
Zhiguang ZHOU
1
,
2
,
5
Author Information
1. Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University
2. Ministry of Education, Key Laboratory of Diabetes Immunology (Central South University)
3. National Clinical Research Center for Metabolic Diseases, Changsha 410011, China. qjl497@163.com.
4. National Clinical Research Center for Metabolic Diseases, Changsha 410011, China. shuomingluo@csu.edu.cn.
5. National Clinical Research Center for Metabolic Diseases, Changsha 410011, China.
- Publication Type:Journal Article
- Keywords:
fulminant;
immune checkpoint inhibitor;
programmed death-1;
type 1 diabetes
- MeSH:
Humans;
Male;
Middle Aged;
Aged;
Female;
Diabetes Mellitus, Type 1;
Programmed Cell Death 1 Receptor;
Immune Checkpoint Inhibitors/therapeutic use*;
Retrospective Studies;
Ketosis;
Autoantibodies
- From:
Journal of Central South University(Medical Sciences)
2023;48(1):49-58
- CountryChina
- Language:English
-
Abstract:
OBJECTIVES:Programmed death 1 (PD-1) associated fulminant type 1 diabetes (PFD) is a rare acute and critical in internal medicine, and its clinical characteristics are still unclear. This study aims to analyze the clinical characteristics of PFD patients to improve clinical diagnosis and treatment.
METHODS:We retrospectively analyzed the clinical data of 10 patients with PFD admitted to the Second Xiangya Hospital of Central South University, combined with the data of 66 patients reported in the relevant literature, analyzed and summarized their clinical and immunological characteristics, and compared the patients with PFD with different islet autoantibody status.
RESULTS:Combined with our hospital and literature data, a total of 76 patients with PFD were reported, with the age of (60.9±12.1) years old, 60.0% male and body mass index of (22.1±5.2) kg/m2. In 76 patients, the most common tumors were lung cancer (43.4%) and melanoma (22.4%). Among PD-1 inhibitors, the most common drugs are nivolumab (37.5%) and pembrolizumab (38.9%). 82.2% of PFD patients developed diabetes ketoacidosis. The median onset time from PD-1 related inhibitor treatment to hyperglycemia was 95 (36.0, 164.5) d, and the median treatment cycle before the onset of diabetes was 6 (2.3, 8.0) cycles. 26% (19/73) of PFD patients had positive islet autoantibodies, and the proportion of ketoacidosis in the positive group was significantly higher than that in the negative group (100.0% vs 75.0%, P<0.05). The onset time and infusion times of diabetes after PD-1 inhibitor treatment in the autoantibody positive group were significantly lower than those in the autoantibody negative group (28.5 d vs 120.0 d; 2 cycles vs 7 cycles, both P<0.001).
CONCLUSIONS:After initiation of tumor immunotherapy, it is necessary to be alert to the occurrence of adverse reactions of PFD, and the onset of PFD with islet autoantibody positive is faster and more serious than that of patients with autoantibodies negative. Detection of islet autoantibodies and blood glucose before and after treatment with PD-1 inhibitors is of great value for early warning and prediction of PFD.
