Qin Kun, Gong Ting, Ruan Shi-Fan, Lin Min, Su Xinhong, Lv Xiaoqing, Cheng Bo, Ji Chao
Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, People's Republic of China.
Department of Dermatology, Jiangmen Central Hospital, Jiangmen, Guangdong, 529000, People's Republic of China.
J Inflamm Res. 2024 Oct 22;17:7591-7605. doi: 10.2147/JIR.S491791. eCollection 2024.
Immune checkpoint inhibitors (ICIs) can cause life-threatening Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Large-scale original research on ICI-induced SJS/TEN is limited. This study aimed to explore the unique clinical characteristics and potential pathophysiological mechanisms of SJS/TEN induced by ICIs.
This cross-sectional study compared the clinical features of SJS/TEN induced by ICIs and non-ICIs, and reviewed the case characteristics of ICI-induced SJS/TEN. Clinical features were analyzed using independent t-tests, Mann-Whitney -tests, and multivariable regression models.
This study enrolled 41 cases of ICI-induced SJS/TEN and 107 non-ICI-induced cases from January 22, 2015, to May 28, 2024. ICI-induced SJS/TEN patients exhibited a trend towards a longer latency period (β: 17, 95% CI: -1.49 to 35.48), a smaller affected body surface area (BSA) (β: -40.68, 95% CI: -71.59 to -9.77), and milder oral and ocular mucositis than non-ICI-induced cases. A literature review identified PD-1 inhibitors as the primary ICIs involved and systemic corticosteroids as the most frequent intervention. No statistically significant difference in mortality rate was observed between patients treated with systemic corticosteroids alone and those receiving combination therapies (P= 0.85). The mortality rate for ICI-induced SJS/TEN was 24.5%.
This study offered the largest comparative analysis to date, highlighting the unique clinical features of ICI-induced SJS/TEN, including a smaller affected BSA, a prolonged latency period trend, and milder oral and ocular mucositis. We described the epidemiology, clinical presentation, and therapeutic strategies for ICI-induced SJS/TEN. These findings not only contribute to a deeper understanding of the complex immune-inflammatory pathways in severe immune-related cutaneous adverse events (ircAEs) but also may inform the development of more targeted and effective treatments.
免疫检查点抑制剂（ICI）可导致危及生命的史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）。关于ICI诱导的SJS/TEN的大规模原创研究有限。本研究旨在探讨ICI诱导的SJS/TEN的独特临床特征和潜在病理生理机制。
本横断面研究比较了ICI诱导和非ICI诱导的SJS/TEN的临床特征，并回顾了ICI诱导的SJS/TEN的病例特征。使用独立t检验、曼-惠特尼检验和多变量回归模型分析临床特征。
本研究纳入了2015年1月22日至2024年5月28日期间41例ICI诱导的SJS/TEN病例和107例非ICI诱导的病例。与非ICI诱导的病例相比，ICI诱导的SJS/TEN患者表现出潜伏期更长的趋势（β：17，95%CI：-1.49至35.48）、受影响的体表面积（BSA）更小（β：-40.68，95%CI：-71.59至-9.77）以及口腔和眼部粘膜炎更轻。文献综述确定PD-1抑制剂是主要涉及的ICI，全身用皮质类固醇是最常用的干预措施。单独使用全身用皮质类固醇治疗的患者与接受联合治疗的患者之间的死亡率无统计学显著差异（P = 0.85）。ICI诱导的SJS/TEN的死亡率为24.5%。
本研究提供了迄今为止最大规模的比较分析，突出了ICI诱导的SJS/TEN的独特临床特征，包括受影响的BSA更小、潜伏期延长趋势以及口腔和眼部粘膜炎更轻。我们描述了ICI诱导的SJS/TEN的流行病学、临床表现和治疗策略。这些发现不仅有助于更深入地了解严重免疫相关皮肤不良事件（ircAE）中复杂的免疫炎症途径，还可能为开发更有针对性和有效的治疗方法提供参考。
