TY - JOUR
T1 - Endoscopic and Histologic Features of Immune Checkpoint Inhibitor-Related Colitis
AU - Wang, Yinghong
AU - Abu-Sbeih, Hamzah
AU - Mao, Emily
AU - Ali, Noman
AU - Qiao, Wei
AU - Trinh, Van Anh
AU - Zobniw, Chrystia
AU - Johnson, Daniel Hartman
AU - Samdani, Rashmi
AU - Lum, Phillip
AU - Shuttlesworth, Gladis
AU - Blechacz, Boris
AU - Bresalier, Robert
AU - Miller, Ethan
AU - Thirumurthi, Selvi
AU - Richards, David
AU - Raju, Gottumukkala
AU - Stroehlein, John
AU - Diab, Adi
N1 - Publisher Copyright:
© 2018 Crohn's & Colitis Foundation. Published by Oxford University Press. All rights reserved.
PY - 2018/8/16
Y1 - 2018/8/16
N2 - Background Diarrhea and colitis are the second most common immune checkpoint inhibitor (ICPI)-induced adverse events. However, a comprehensive characterization of the endoscopic and histologic features of ICPI-induced diarrhea and colitis is lacking. Therefore, we aimed to describe endoscopic and histologic features of ICPI-induced gastrointestinal toxicities and to assess their association with patients' clinical characteristics and outcomes. Methods We retrospectively reviewed records of 53 patients with ICPI-related diarrhea/colitis between 2011 and 2017. We collected data on demographics, diarrhea/colitis grade, treatment, and endoscopic and histologic findings. Long-term follow-up included repeat endoscopy findings, diarrhea recurrence, and overall survival. We compared groups by treatment, endoscopic and histologic findings, and constructed Kaplan-Meier survival curves. Results Most patients had grade 2 or higher diarrhea (87%) and colitis (60%). Thirty-one patients were successfully treated with corticosteroids, and 22 additionally required infliximab. On endoscopy, 21 (40%) patients had ulcerations and 22 (42%) had nonulcerative inflammation. Patients with ulcerations had more steroid-refractory disease (P = 0.044) and high-grade diarrhea (P = 0.033). Histology showed mostly acute (23%) or chronic (60%) inflammation. During mean follow-up duration of 18.9 months, 19 (36%) developed recurrent diarrhea. Most patients had persistent endoscopic (8/13, 62%) and histologic (9/11, 82%) inflammation. Patients with higher-grade adverse events had improved survival. Higher-grade colitis was associated with endoscopic inflammation (P = 0.039), but grade of diarrhea was not associated with endoscopic inflammation or grade of colitis. Conclusion 10.1093/ibd/izy104-video1 izy104.video1 5808053084001.
AB - Background Diarrhea and colitis are the second most common immune checkpoint inhibitor (ICPI)-induced adverse events. However, a comprehensive characterization of the endoscopic and histologic features of ICPI-induced diarrhea and colitis is lacking. Therefore, we aimed to describe endoscopic and histologic features of ICPI-induced gastrointestinal toxicities and to assess their association with patients' clinical characteristics and outcomes. Methods We retrospectively reviewed records of 53 patients with ICPI-related diarrhea/colitis between 2011 and 2017. We collected data on demographics, diarrhea/colitis grade, treatment, and endoscopic and histologic findings. Long-term follow-up included repeat endoscopy findings, diarrhea recurrence, and overall survival. We compared groups by treatment, endoscopic and histologic findings, and constructed Kaplan-Meier survival curves. Results Most patients had grade 2 or higher diarrhea (87%) and colitis (60%). Thirty-one patients were successfully treated with corticosteroids, and 22 additionally required infliximab. On endoscopy, 21 (40%) patients had ulcerations and 22 (42%) had nonulcerative inflammation. Patients with ulcerations had more steroid-refractory disease (P = 0.044) and high-grade diarrhea (P = 0.033). Histology showed mostly acute (23%) or chronic (60%) inflammation. During mean follow-up duration of 18.9 months, 19 (36%) developed recurrent diarrhea. Most patients had persistent endoscopic (8/13, 62%) and histologic (9/11, 82%) inflammation. Patients with higher-grade adverse events had improved survival. Higher-grade colitis was associated with endoscopic inflammation (P = 0.039), but grade of diarrhea was not associated with endoscopic inflammation or grade of colitis. Conclusion 10.1093/ibd/izy104-video1 izy104.video1 5808053084001.
KW - adverse event
KW - colitis
KW - diarrhea
KW - endoscopy
KW - histology
KW - immune checkpoint inhibitor
KW - immunotherapy
UR - http://www.scopus.com/inward/record.url?scp=85054005535&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85054005535&partnerID=8YFLogxK
U2 - 10.1093/ibd/izy104
DO - 10.1093/ibd/izy104
M3 - Article
C2 - 29718308
AN - SCOPUS:85054005535
SN - 1078-0998
VL - 24
SP - 1695
EP - 1705
JO - Inflammatory bowel diseases
JF - Inflammatory bowel diseases
IS - 9
ER -