Original ArticleResearch CorrespondenceUse of Immune Checkpoint Inhibitors in Patients With Pre-established Inflammatory Bowel Diseases: Retrospective Case Series
Section snippets
Methods
Electronic medical records from January 1999 to December 2019 were reviewed at a single institution to identify patients with co-occurrence of International Classification of Diseases, 9th/10th revision, codes for Crohn’s disease (CD) or ulcerative colitis (UC) and use of ICIs (pembrolizumab, nivolumab, ipilimumab, atezolizumab, durvalumab, and avelumab). Data on demographics, type of malignancy, CD/UC phenotype, and medication were obtained. A diagnosis of CD or UC was confirmed by chart
Results
A total of 341 patients with possible co-occurrence of IBD and use of ICI were identified. Thirteen patients met inclusion criteria (5 CD and 8 UC). Most were males (53.8%). The median follow-up evaluation from initiation of ICI was 18.9 months for UC and 22.8 months for CD (Table 1). The most common malignancy was melanoma (53.8%). Pembrolizumab and nivolumab were used in 61.5% and 38.5% of patients, respectively. One patient was on combination ipilimumab/nivolumab. In CD patients, the most
Discussion
In this article, we describe a case series of patients with pre-established IBD requiring use of ICI for malignancy (8 UC and 5 CD). An IBD flare occurred in 4 cases (30.7%) after initiation of ICI, with a median follow-up period of 22.6 months. Only 1 patient who experienced a flare during ICI treatment was on biologic therapy before initiation of ICI. Interestingly, only 1 of 5 patients who were not on any therapy for IBD during ICI treatment developed a flare.
Among ICIs, the incidence of
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Conflicts of interest This author discloses the following: Edward V. Loftus Jr has consulted for AbbVie, Allergan, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion Healthcare, Eli Lilly, Genentech, Gilead, Janssen, Pfizer, Takeda, and UCB Biopharma, and has received research support from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Genentech, Gilead, Janssen, Pfizer, Robarts Clinical Trials, Takeda, and UCB Biopharma. The remaining authors disclose no conflicts.