Budesonide treatment for microscopic colitis from immune checkpoint inhibitors

Autor: Riley Fadden, Gabriel E. Molina, Michael Dougan, Vikram Deshpande, Hui Zheng, Ryan J. Sullivan, Steven T. Chen, Michael S. Hughes
Rok vydání: 2019
Předmět:
Male
0301 basic medicine
Budesonide
Cancer Research
medicine.medical_specialty
Biopsy
Immunology
Colonoscopy
lcsh:RC254-282
Severity of Illness Index
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Microscopic colitis
Internal medicine
Severity of illness
medicine
Humans
Immunology and Allergy
Intestinal Mucosa
Colitis
Aged
Retrospective Studies
Pharmacology
Enterocolitis
medicine.diagnostic_test
business.industry
Retrospective cohort study
Middle Aged
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
medicine.disease
3. Good health
Colitis
Microscopic
Treatment Outcome
030104 developmental biology
Oncology
030220 oncology & carcinogenesis
Cohort
Molecular Medicine
Female
medicine.symptom
business
Immunosuppressive Agents
Research Article
medicine.drug
Zdroj: Journal for Immunotherapy of Cancer
Journal for ImmunoTherapy of Cancer, Vol 7, Iss 1, Pp 1-10 (2019)
ISSN: 2051-1426
Popis: Background Immune checkpoint inhibitors (CPIs) are effective against a variety of malignancies but can be limited by inflammatory toxicities such as enterocolitis. Enterocolitis is typically treated with systemically active glucocorticoids. Endoscopy can stratify patients by the severity of mucosal inflammation, including identifying patients with colitis in the absence of visible mucosal changes: microscopic colitis. Whether patients with CPI microscopic colitis could be managed differently from colitis with more severe mucosal involvement is unclear. The objective of this study was to describe outcomes in CPI microscopic colitis focusing on the response to first line treatment with budesonide. Methods We evaluated data from a retrospective cohort from a single-center large academic hospital. The participants were all adult patients evaluated by endoscopy for suspected CPI enterocolitis between 3/2017 and 3/2019. The exposures were: Mayo Endoscopic Score (range 0–3). The subset was: oral budesonide, maximum dose 12 mg daily, administered minimum of 5 weeks. The main outcomes and measures were: Primary: time from first CPI exposure to first glucocorticoid use; use of systemic glucocorticoids; time from symptom onset to resolution; continuation of CPI therapy; number of additional CPI infusions received. Secondary: admissions for symptom control; novel irAE development; need for second-line immunosuppression; oncologic outcomes. Results We identified 38 patients with biopsy confirmed CPI enterocolitis, 13 in the microscopic colitis cohort, and 25 in the non-microscopic colitis cohort. Budesonide use was higher in the microscopic colitis cohort (12/13 vs 3/25, p
Databáze: OpenAIRE
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