Expert Clinical Management of Severe Immune-Related Adverse Events : Results from a Multicenter Survey on Hot Topics for Management
Riveiro Barciela, Mar (Hospital Universitari Vall d'Hebron)
Soler, María José (Hospital Universitari Vall d'Hebron)
Barreira-Diaz, Ana (Hospital Universitari Vall d'Hebron)
Bermejo García, Sheila (Hospital Universitari Vall d'Hebron)
Bruera, Sebastian (Baylor College of Medicine (Houston, Estats Units d'Amèrica))
Suarez-Almazor, Maria E. (The University of Texas MD Anderson Cancer Center)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	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.
Grants:	Instituto de Salud Carlos III PI17/00257 Instituto de Salud Carlos III PI21/01292 Ministerio de Economía y Competitividad RD16/0009/0030
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Acute kidney injury ; Immune checkpoint inhibitors ; Immune-related hepatitis ; Immunotherapy ; Myocarditis ; Myositis
Published in:	Journal of clinical medicine, Vol. 11 Núm. 20 (october 2022) , p. 5977, ISSN 2077-0383

DOI: 10.3390/jcm11205977
PMID: 36294298

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