TY - JOUR
T1 - Can Immune Checkpoint Inhibitors Induce Microscopic Colitis or a Brand New Entity?
AU - Choi, Kati
AU - Abu-Sbeih, Hamzah
AU - Samdani, Rashmi
AU - Nogueras Gonzalez, Graciela
AU - Raju, Gottumukkala Subba
AU - Richards, David M.
AU - Gao, Jianjun
AU - Subudhi, Sumit
AU - Stroehlein, John
AU - Wang, Yinghong
N1 - Funding Information:
Received for publications March 11, 2018; Editorial Decision June 8, 2018. From the *Department of Internal Medicine, Baylor College of Medicine, Houston, Texas; †Department of Gastroenterology, Hepatology and Nutrition, ‡Department of Pathology, §Department of Biostatistics, and ¶Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas Conflicts of interest: The authors have no conflicts of interest to report. Medical writing support for development of this paper was provided by the Office of Scientific Publications at the MD Anderson Cancer Center. Address correspondence to: Yinghong Wang, MD, PhD, Department of Gastroenterology, Hepatology and Nutrition, Unit 1466, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030 (ywang59@mdanderson.org).
Publisher Copyright:
© 2018 Crohn's & Colitis Foundation. Published by Oxford University Press. All rights reserved.
PY - 2019/1/10
Y1 - 2019/1/10
N2 - Background Microscopic colitis (MC) has been described as 1 pattern of injury in immune checkpoint inhibitor (ICPI)-induced colitis. The main objective of this study was to characterize ICPI-induced MC by exploring the differences in risk factors, colitis treatments, endoscopic features, and clinical outcomes between cancer and noncancer patients with MC with and without exposure to ICPIs. Methods A retrospective chart review was conducted among patients diagnosed with MC from our institutional pathology database from January 2012 to January 2018. Patients were categorized into MC in cancer patients with or without ICPI exposure and in noncancer patients. Risk factors (use of tobacco and certain medications), colitis treatments (antidiarrheals and immunosuppressants), endoscopic features (with or without mucosal abnormality), and clinical outcomes (diarrhea recurrence, hospitalization, mortality) were collected and compared among the 3 groups. Results Of the 65 eligible patients with MC, 15 cancer patients had exposure to ICPI, 39 cancer patients had no exposure to ICPI, and 11 had no cancer diagnosis. Among the risk factors, proton pump inhibitor was more frequently used in the ICPI-induced MC cohort (P = 0.040). Furthermore, in this population, mucosal abnormality was the most common endoscopic feature compared with normal findings in the non-ICPI-induced MC groups (P = 0.106). Patients with ICPI-induced MC required more treatments with oral and intravenous steroids and nonsteroidal immunosuppressive agents (all P < 0.001) and had a higher rate of hospitalization (P < 0.001). Conclusion This study suggests that despite some similarities between MC with and without exposure to ICPIs, ICPI-induced MC has a more aggressive disease course that requires more potent immunosuppressive treatment regimens and greater need for hospitalization.
AB - Background Microscopic colitis (MC) has been described as 1 pattern of injury in immune checkpoint inhibitor (ICPI)-induced colitis. The main objective of this study was to characterize ICPI-induced MC by exploring the differences in risk factors, colitis treatments, endoscopic features, and clinical outcomes between cancer and noncancer patients with MC with and without exposure to ICPIs. Methods A retrospective chart review was conducted among patients diagnosed with MC from our institutional pathology database from January 2012 to January 2018. Patients were categorized into MC in cancer patients with or without ICPI exposure and in noncancer patients. Risk factors (use of tobacco and certain medications), colitis treatments (antidiarrheals and immunosuppressants), endoscopic features (with or without mucosal abnormality), and clinical outcomes (diarrhea recurrence, hospitalization, mortality) were collected and compared among the 3 groups. Results Of the 65 eligible patients with MC, 15 cancer patients had exposure to ICPI, 39 cancer patients had no exposure to ICPI, and 11 had no cancer diagnosis. Among the risk factors, proton pump inhibitor was more frequently used in the ICPI-induced MC cohort (P = 0.040). Furthermore, in this population, mucosal abnormality was the most common endoscopic feature compared with normal findings in the non-ICPI-induced MC groups (P = 0.106). Patients with ICPI-induced MC required more treatments with oral and intravenous steroids and nonsteroidal immunosuppressive agents (all P < 0.001) and had a higher rate of hospitalization (P < 0.001). Conclusion This study suggests that despite some similarities between MC with and without exposure to ICPIs, ICPI-induced MC has a more aggressive disease course that requires more potent immunosuppressive treatment regimens and greater need for hospitalization.
KW - collagenous colitis
KW - immune checkpoint inhibitors
KW - lymphocytic colitis
KW - microscopic colitis
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U2 - 10.1093/ibd/izy240
DO - 10.1093/ibd/izy240
M3 - Article
C2 - 30169584
AN - SCOPUS:85059044036
SN - 1078-0998
VL - 25
SP - 385
EP - 393
JO - Inflammatory bowel diseases
JF - Inflammatory bowel diseases
IS - 2
ER -