Centre of Endocrinology, Diabetes and Metabolism, Limassol, Cyprus.
Institute of Metabolism and Systems Research, Birmingham, UK and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Clin Med (Lond). 2020 Jul;20(4):417-423. doi: 10.7861/clinmed.2020-0054.
Pembrolizumab is an anti-cancer drug that targets programmed cell death protein-1 (PD-1) receptors on lymphocytes resulting in their activation against tumour cells. PD-1 receptors are also interspersed in endocrine organs and pembrolizumab use has long been associated with hypophysitis and thyroiditis. Since the introduction of immune checkpoint inhibitors (ICI), several cases of fulminant type 1 diabetes mellitus (FT1DM) have been reported. However, it is unclear if FT1DM and ICI-induced diabetes are the same pathology. We review the existing literature of ICI-induced diabetes to investigate its nature and to what extent it represents type 1A diabetes and/or FT1DM (type 1B diabetes) using an example case. Our review showed that ICI-induced diabetes may be a different entity to FT1DM. Furthermore, there is limited evidence for the management of ICI-induced T1DM. Further research into its pathophysiology will improve management and possibly prevent this burdensome complication.
派姆单抗是一种抗癌药物，针对淋巴细胞上的程序性细胞死亡蛋白-1（PD-1）受体，从而激活其对抗肿瘤细胞。PD-1 受体也散布在内分泌器官中，派姆单抗的使用长期以来一直与垂体炎和甲状腺炎有关。自从免疫检查点抑制剂（ICI）问世以来，已经报道了几例暴发性 1 型糖尿病（FT1DM）。然而，尚不清楚 FT1DM 和 ICI 诱导的糖尿病是否为同一病理。我们回顾了现有的 ICI 诱导性糖尿病文献，以研究其性质，并通过一个例子来探讨其在多大程度上代表 1 型 A 糖尿病和/或 FT1DM（1 型 B 糖尿病）。我们的综述表明，ICI 诱导的糖尿病可能与 FT1DM 不同。此外，ICI 诱导的 T1DM 的治疗证据有限。进一步研究其病理生理学将改善管理，并可能预防这种负担沉重的并发症。
