PD-1/PD-L1 抑制剂相关垂体炎:来自 FAERS 数据库和病例报告的分析。

PD-1/PD-L1 inhibitors associated hypophysitis: An analysis from the FAERS database and case reports.

机构信息

Department of Pharmacy, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.

Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China.

出版信息

Drug Discov Ther. 2024 Mar 20;18(1):34-43. doi: 10.5582/ddt.2023.01092. Epub 2024 Feb 20.

Abstract

To get a thorough understanding of PD-1/L1 inhibitor-related hypophysitis (PD-1/L1-irH), we utilized a combination of disproportionality analysis and case analysis to comprehensively characterize the clinical features of PD-1/L1-irH. Significant signals of hypophysitis were detected for all PD-1/PD-L1 inhibitors in the FAERS (FDA Adverse Event Reporting System). As revealed by both FAERS and the case analysis, PD-1/L1-irH occurred more commonly in males, PD-1 inhibitors users and patients older than 65 years. The median onset time was 101 days in FAERS and 8 cycles in the case analysis. In the case analysis, eight late-onset PD-1/L1-irHs occurred even after a discontinuation of several months (4-15 months). As revealed in FAERS, the outcome of PD-1/L1-irH tended to be poor, generally resulting in 64.66% hospitalization and 12.59% death. Fatigue was the most prominent symptom of PD-1/L1-irH, followed by anorexia, hyponatremia, and hypotension, as revealed by the analysis of 84 cases. Meanwhile isolated adrenocorticotropic (ACTH) deficiency was particularly prevalent for PD-1/L1-irH (85.71%), while gonadal hormones or posterior pituitary hormones deficiencies were rare. Glucocorticoids were administered to almost all cases (81/84), with a physiologic or stress dosage in 61.9% of cases, and a high-dose in 26.2% of cases. Most cases (58.3%) showed a favorable tumor response before diagnosis of PD-1/L1-irH. PD-1/L1-irH may occur throughout the whole therapy period even after discontinuation. Clinicians should pay more attention to PD-1 inhibitor users, males and older patients. Early diagnosis and prompt managements are crucial for PD-1/L1-irH as its potentially life-threatening nature.

摘要

为了全面了解 PD-1/L1 抑制剂相关垂体炎(PD-1/L1-irH),我们采用了比例失调分析和病例分析相结合的方法,全面描述了 PD-1/L1-irH 的临床特征。所有 PD-1/PD-L1 抑制剂在 FAERS(FDA 不良事件报告系统)中均显示出垂体炎的显著信号。无论是 FAERS 还是病例分析都表明,PD-1/L1-irH 更常见于男性、PD-1 抑制剂使用者和 65 岁以上的患者。FAERS 中的中位发病时间为 101 天,病例分析中为 8 个周期。在病例分析中,即使在停药数月(4-15 个月)后,仍有 8 例迟发性 PD-1/L1-irH 发生。FAERS 显示,PD-1/L1-irH 的结局往往较差,通常导致 64.66%的住院治疗和 12.59%的死亡。疲劳是 PD-1/L1-irH 最突出的症状,其次是厌食、低钠血症和低血压,84 例分析显示。同时,孤立性促肾上腺皮质激素(ACTH)缺乏症在 PD-1/L1-irH 中特别普遍(85.71%),而性腺激素或垂体后叶激素缺乏症则很少见。几乎所有病例(81/84)都使用了糖皮质激素,61.9%的病例使用生理剂量或应激剂量,26.2%的病例使用高剂量。大多数病例(58.3%)在诊断为 PD-1/L1-irH 之前显示出有利的肿瘤反应。PD-1/L1-irH 甚至在停药后也可能在整个治疗期间发生。临床医生应更加关注 PD-1 抑制剂使用者、男性和老年患者。早期诊断和及时治疗对于 PD-1/L1-irH 至关重要,因为其具有潜在的致命性。

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