Department of Pharmacy, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, 410011, China.
Department of pharmacy, Yinan County People's Hospital, Linyi, Shandong, 276300, China.
Invest New Drugs. 2023 Dec;41(6):802-807. doi: 10.1007/s10637-023-01397-w. Epub 2023 Sep 29.
Bullous pemphigoid (BP) is a serious and rare complication of nivolumab. This study aimed to explore the clinical characteristics of nivolumab-induced BP and provide a reference for prevention and treatment of BP.
Literature on nivolumab-induced BP was collected for retrospective analysis by searching both Chinese and English databases as of July 31, 2023.
Sixty patients were included, with a median age of 71 years (range 30 to 85 years), and they were predominantly male (78.3%). The median time to onset of BP was 31 weeks (range 2.4, 216) after nivolumab administration. Tense bullae (93.3%), pruritus (55.0%), and urticarial plaques (31.7%) were the most common manifestations. Lesions were found on the limbs (50.0%), trunk (38.3%), palms and soles (15.0%). Skin biopsies mainly showed subepidermal bullous/blister (50.0%) and eosinophilic infiltration (46.7%). Direct immunofluorescence showed mainly linear deposition of C3 and IgG (46.7%) at the dermal-epidermal junction. The patients stopped taking nivolumab and received systemic steroids (73.3%), topical steroids (63.3%), monoclonal antibodies (21.7%), doxycycline/minocycline (30.0%) and other treatments. Symptoms improved or were relieved in 88.4% of patients but did not improve in 8.3% of patients.
Clinicians should closely monitor symptoms of BP in those receiving and discontinuing nivolumab, especially in older men. Early diagnosis and timely initiation of treatment may improve patient outcomes.
大疱性类天疱疮（BP）是纳武利尤单抗的一种严重且罕见的并发症。本研究旨在探讨纳武利尤单抗诱导的 BP 的临床特征，为 BP 的预防和治疗提供参考。
通过检索中文和英文数据库，截至 2023 年 7 月 31 日，对纳武利尤单抗诱导的 BP 相关文献进行回顾性分析。
共纳入 60 例患者，中位年龄 71 岁（范围 30-85 岁），男性居多（78.3%）。纳武利尤单抗治疗后 BP 的中位发病时间为 31 周（范围 2.4-216）。最常见的表现为紧张性大疱（93.3%）、瘙痒（55.0%）和荨麻疹样斑块（31.7%）。皮损见于四肢（50.0%）、躯干（38.3%）、手掌和足底（15.0%）。皮肤活检主要表现为表皮下水疱/大疱（50.0%）和嗜酸性粒细胞浸润（46.7%）。直接免疫荧光显示主要为 C3 和 IgG 在真皮-表皮交界处线状沉积（46.7%）。患者停用纳武利尤单抗，接受全身皮质类固醇（73.3%）、局部皮质类固醇（63.3%）、单克隆抗体（21.7%）、多西环素/米诺环素（30.0%）和其他治疗。88.4%的患者症状改善或缓解，8.3%的患者无改善。
临床医生应密切监测接受和停用纳武利尤单抗的患者的 BP 症状，尤其是老年男性。早期诊断和及时治疗可能改善患者的预后。
