Chen Li, Cao Xin, Luo Xing, Jiang Ting
Department of Pharmacy, Wusheng People's Hospital, 513 Jianshe North Road, Wusheng County, Guangan, 638400, Sichuan, China.
General Practice Department, Clinical Medical College and the First Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan South Road, Nanchong, 637000, Sichuan, China.
Heliyon. 2024 Jul 4;10(14):e34107. doi: 10.1016/j.heliyon.2024.e34107. eCollection 2024 Jul 30.
Several immune related adverse events (irAEs) were reported with the wide application of immune checkpoint inhibitors (ICIs) in tumors. ICI-related skin reactions are the most common, which are manifested as maculopapules, rash, pruritus, vitiligo, psoriasis, and lichenoid rash.Among them, the incidence of pruritus is second only to maculopapule/rash, but both often co-exist. The severity of pruritus is mostly mild to moderate and can be relieved after symptomatic treatment with antihistamines. Symptoms are slightly relieved after conventional treatment in patients with severe pruritus, but it easily recurs and eventually develops into refractory pruritus.The patient's quality of life may be affected and may also be life-threatening. We report a case of a patient with postoperative recurrence of gallbladder neuroendocrine carcinoma,who developed refractory pruritus after sintilimab use, which was relieved after naloxone infusion after unsuccessful conventional drug therapy. By analyzing the treatment plan of this typical case of immune-related refractory pruritus after using sintilimab, this report discusses how clinical pharmacists can provide individualized treatment of patients by using their expertise and clinicians' cooperation and complementation in treating clinically difficult cases. This case report may be used as a reference in treating patients with refractory pruritus after the clinical use of sintilimab.
随着免疫检查点抑制剂（ICI）在肿瘤治疗中的广泛应用，有多种免疫相关不良事件（irAE）被报道。ICI相关的皮肤反应最为常见，表现为斑丘疹、皮疹、瘙痒、白癜风、银屑病和苔藓样皮疹。其中，瘙痒的发生率仅次于斑丘疹/皮疹，但二者常同时存在。瘙痒的严重程度大多为轻至中度，使用抗组胺药进行对症治疗后可缓解。重度瘙痒患者经常规治疗后症状稍有缓解，但易复发，最终发展为难治性瘙痒。这可能会影响患者的生活质量，甚至危及生命。我们报告1例胆囊神经内分泌癌术后复发患者，使用信迪利单抗后出现难治性瘙痒，在常规药物治疗无效后经纳洛酮输注缓解。通过分析这例使用信迪利单抗后出现免疫相关难治性瘙痒的典型病例的治疗方案，本报告探讨了临床药师如何利用自身专业知识，通过与临床医生合作互补，为患者提供个体化治疗，处理临床疑难病例。本病例报告可为临床使用信迪利单抗后出现难治性瘙痒的患者治疗提供参考。
