Literature and case analysis of pemphigoid caused by immune checkpoint inhibitors
10.3760/cma.j.cn114015-20220512-00417
- VernacularTitle:免疫检查点抑制剂相关类天疱疮文献病例分析
- Author:
Xiuhua WENG
1
;
Xiaojia HUANG
;
Yaping HUANG
;
Bo CHENG
Author Information
1. 福建医科大学附属第一医院药学部，福州 350005
- Publication Type:Journal Article
- Keywords:
Immune checkpoint inhibitors;
Pemphigoid, bullous;
Immune-related adverse events
- From:
Adverse Drug Reactions Journal
2022;24(12):652-657
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical characteristics of pemphigoid caused by immune checkpoint inhibitors (ICIs).Methods:The relevant databases at home and abroad (up to October 15, 2021) were searched and the case reports on pemphigoid caused by ICIs were collected. The relevant information of patients (gender, age, tumor type, drug varieties of ICIs, incubation period of pemphigoid, main symptoms, distribution site of lesions, biopsy and immunological examination, treatment and outcome, etc.) were collected and analyzed descriptively.Results:A total of 82 relevant literature were included, involving 103 patients, 72 males and 31 females, aged 30-90 years, of which 82 (79.6%) were ≥60 years old. The primary diseases were melanoma in 45 cases (43.7%) and lung cancer in 29 cases (28.2%). The 103 patients involved 6 varieties of ICI, including programmed cell death 1 receptors [pablizumab (47 cases, 45.6%), navulizumab (44 cases, 42.7%), and terepril (4 cases, 3.9%)], and programmed cell death ligand 1 inhibitors [atezumab (3 cases, 2.9%), duvalizumab (2 cases, 1.9%)], and CTLA-4 inhibitor ipimamab (3 cases, 2.9%). Eighty-four patients had a record of the time from the beginning of ICI to the occurrence (incubation period) of pemphigoid. The incubation period of pabolizumab was 3-850 days, of navulizumab was 21-790 days, and of terepril was 70-728 days. Among 103 patients, 88 (85.4%) were bullous pemphigoid, 8 (7.8%) were mucous pemphigoid, 4 (3.9%) were non bullous pemphigoid, and 1 (1.0%) was dyshidrosiform pemphigoid; the clinical manifestations were bullous and vesicular lesions in 98 cases (95.1%), rash in 51 cases (49.5%), and pruritus in 48 cases (45.6%). Nine four patients had skin biopsy results, 78 patients (83.0%) had eosinophil infiltration in the lesion site; immunological examination was performed in 92 cases (97.8%), of which 63 cases (68.5%) were IgG and C3 deposits. Thirty-five patients had pemphigoid associated antigen test records, BP180 was detected in 25 patients, and 24 patients (96%) were positive; BP180 and BP 230 were detected simultaneously in 8 cases, both were positive in 6 cases, and BP180 was positive and BP 230 was negative in the other 2 cases; BP-Ag2 was detected in 2 cases, all of them were positive. After treatment with glucocorticoid or immunosuppressant and/or withdrawal of ICIs, 86 (83.5%) of 103 patients were improved, and 6 were not; 8 cases died, of which 7 cases of pemphigoid were improved but died of other causes, and 1 case died of unreported causes; 9 cases did not report the outcome.Conclusions:ICIs can cause pemphigoid, and the incidence in the elderly is higher. The incubation period of pemphigoid varies from 3 days to more than 2 years. After glucocorticoid or immunosuppressant treatment and/or withdrawal of ICIs, most patients had good prognosis.
