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 |
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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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