Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Postgraduate Clinical Training Center, Hokkaido University Hospital, Sapporo, Japan.
J Diabetes Investig. 2019 Sep;10(5):1385-1387. doi: 10.1111/jdi.13022. Epub 2019 Mar 19.
With the expansive use of immune checkpoint inhibitors, the frequency of immune-related adverse events, including autoimmune type 1 diabetes, has been exponentially increased. The anti-programmed death-ligand 1 antibody, avelumab, has recently been approved for metastatic Merkel cell carcinoma therapy. Here, we report a patient that developed fulminant type 1 diabetes during avelumab treatment. An 81-year-old woman with no history of diabetes received avelumab for metastatic Merkel cell carcinoma. Elevated plasma glucose level (483 mg/dL), hemoglobin A1c level (7.5%) and ketosis were observed after 10 courses of avelumab without any symptoms related to hyperglycemia. As the laboratory tests showed insulin depletion, we diagnosed her with fulminant type 1 diabetes induced by avelumab. This is the first reported case of avelumab-induced type 1 diabetes, illustrating the necessity for close monitoring of glycemic control during avelumab therapy, as well as other immune checkpoint inhibitors.
随着免疫检查点抑制剂的广泛应用，包括自身免疫性 1 型糖尿病在内的免疫相关不良事件的频率呈指数级增加。抗程序性死亡配体 1 抗体avelumab 最近已被批准用于转移性 Merkel 细胞癌的治疗。在这里，我们报告了一例在avelumab 治疗期间发生暴发性 1 型糖尿病的患者。一位 81 岁的女性，无糖尿病病史，因转移性 Merkel 细胞癌接受avelumab 治疗。在接受avelumab 治疗 10 个疗程后，患者出现高血糖（483mg/dL）、血红蛋白 A1c 水平（7.5%）和酮症，但无与高血糖相关的症状。由于实验室检查显示胰岛素耗竭，我们诊断她患有由avelumab 引起的暴发性 1 型糖尿病。这是首例报道的avelumab 诱导的 1 型糖尿病病例，表明在avelumab 治疗期间需要密切监测血糖控制，以及其他免疫检查点抑制剂。
