82c73c6b1a3180c27d77e85a14acf2a9 292102.pdf 5eebb78efe708735f19916afc06b771dbdb579a0 292102.pdf ac2e80419258f6995c81f2e70a29199d977b55e71e47ca07a14413894a259151 292102.pdf Title: Expert Clinical Management of Severe Immune-Related Adverse Events: Results from a Multicenter Survey on Hot Topics for Management Subject: There are differences in recommendations for the management of immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs). To assess the real-world management of irAEs, three surveys regarding ICI-induced hepatitis (IIH), renal irAEs, and myositis were developed and sent to experts in each area. Fifty-six surveys were completed (17 IIH, 20 renal irAEs, and 19 myositis). All experts agreed on performing imaging in every suspected case of severe IIH. Sixty-five percent agreed on performing a liver biopsy in patients not responding to corticosteroids. The most common indication for corticosteroid use (59%) was for severe IIH not improving after discontinuation of ICIs. Additionally, 60% of the experts agreed on performing a biopsy for stage 2/3 acute kidney injury (AKI), and 70% recommended imaging for any stage of AKI. Thirty-five percent favored corticosteroids in AKI patients with creatinine levels 2–3-fold above baseline. For myositis, 58% would recommend a muscle biopsy in a patient with weakness and creatine kinase levels of 5000 U/L; 47% would also opt for an endomyocardial biopsy when the troponin levels are increased. Fifty-eight percent recommended oral corticosteroids for myositis, and 37% recommended additional therapy, mainly immunoglobulins. These results show substantial differences in expert practice patterns for the management of severe liver, kidney, and muscular irAEs. Keywords: immune checkpoint inhibitors; immunotherapy; immune-related hepatitis; acute kidney injury; myositis; myocarditis Author: Mar Riveiro-Barciela, Maria Jose Soler, Ana Barreira-Diaz, Sheila Bermejo, Sebastian Bruera and Maria E. Suarez-Almazor Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Wed Oct 12 08:25:08 2022 CEST ModDate: Wed Oct 12 08:27:22 2022 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 15 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 818364 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- NCUGIZ+VnURWPalladioL Type 1 Custom yes yes no 10 0 HAFHEW+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 HVGCEX+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 ERSQGY+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 QGYAWM+SFRM0800 Type 1 Custom yes yes no 28 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 47 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 50 0 URYLRZ+URWPalladioL-BoldItal Type 1 Custom yes yes no 75 0 FOCAMK+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 92 0 FOCAMM+PalatinoLinotype TrueType WinAnsi yes yes no 95 0 FOCAMO+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 98 0 FOCAMK+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 115 0 FOCAMM+PalatinoLinotype TrueType WinAnsi yes yes no 118 0 FOCAMO+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 121 0 TCNQLZ+CMSY10 Type 1 Builtin yes yes no 134 0 TMHVPV+MSAM10 Type 1 Builtin yes yes no 148 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-05-22 02:41:37 CEST RepresentationInformation: 292102.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-05-21 17:16:57 CEST Size: 818364 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 278 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Study Design Destination: subsection.2.1 Item: Title: Participants Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Management of Severe IIH (Grade 3 or 4) Destination: subsection.3.1 Children: Item: Title: Participants Destination: subsubsection.3.1.1 Item: Title: Diagnosis Destination: subsubsection.3.1.2 Item: Title: Treatment Destination: subsubsection.3.1.3 Item: Title: Management of Renal irAEs Destination: subsection.3.2 Children: Item: Title: Participants Destination: subsubsection.3.2.1 Item: Title: Diagnosis Destination: subsubsection.3.2.2 Item: Title: Treatment Destination: subsubsection.3.2.3 Item: Title: Management of Immune-Related Myositis Destination: subsection.3.3 Children: Item: Title: Participants Destination: subsubsection.3.3.1 Item: Title: Diagnosis Destination: subsubsection.3.3.2 Item: Title: Treatment Destination: subsubsection.3.3.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: Appendix A Destination: section.A. Item: Title: References Destination: Item.57 Info: Title: Expert Clinical Management of Severe Immune-Related Adverse Events: Results from a Multicenter Survey on Hot Topics for Management Author: Mar Riveiro-Barciela, Maria Jose Soler, Ana Barreira-Diaz, Sheila Bermejo, Sebastian Bruera and Maria E. Suarez-Almazor Subject: There are differences in recommendations for the management of immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs). To assess the real-world management of irAEs, three surveys regarding ICI-induced hepatitis (IIH), renal irAEs, and myositis were developed and sent to experts in each area. Fifty-six surveys were completed (17 IIH, 20 renal irAEs, and 19 myositis). All experts agreed on performing imaging in every suspected case of severe IIH. Sixty-five percent agreed on performing a liver biopsy in patients not responding to corticosteroids. The most common indication for corticosteroid use (59%) was for severe IIH not improving after discontinuation of ICIs. Additionally, 60% of the experts agreed on performing a biopsy for stage 2/3 acute kidney injury (AKI), and 70% recommended imaging for any stage of AKI. Thirty-five percent favored corticosteroids in AKI patients with creatinine levels 2 3-fold above baseline. For myositis, 58% would recommend a muscle biopsy in a patient with weakness and creatine kinase levels of 5000 U/L; 47% would also opt for an endomyocardial biopsy when the troponin levels are increased. Fifty-eight percent recommended oral corticosteroids for myositis, and 37% recommended additional therapy, mainly immunoglobulins. These results show substantial differences in expert practice patterns for the management of severe liver, kidney, and muscular irAEs. 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