Immune checkpoint inhibitor–induced bullous pemphigoid: Towards a new class of drug-drug interaction?

PUJALTE-MARTIN, Marc; Rocher, Fanny; Cardot‐Leccia, Nathalie; Giacchero, Damien; Borchiellini, Delphine

doi:10.1016/j.ejca.2020.07.027

Cited by 3 publications

(3 citation statements)

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“…The levels of BP180 autoantibodies were elevated in 46 of 57 patients (80.7%), whereas BP230 autoantibody levels were elevated in only 9 of 31 patients (29.0%). Additional laboratory findings were reported in 26 patients, with an elevated serum eosinophil count (n = 13) being the most common finding.…”

Section: Resultsmentioning

confidence: 85%

“…Reference lists of the 139 eligible articles were also screened for additional articles, and 77 articles met the eligibility criteria after screening. Among these, 70 articles reporting clinical data from 127 individual patients were reviewed to include in the analytic component of the systematic review. The 7 other articles provided predominantly summarized data, with limited and inconsistent data from individual patients.…”

Section: Resultsmentioning

confidence: 99%

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Association of Bullous Pemphigoid With Immune Checkpoint Inhibitor Therapy in Patients With Cancer

et al. 2022

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IMPORTANCEThere is limited information on immune checkpoint inhibitor-induced bullous pemphigoid (ICI-BP) in patients with cancer, with most existing studies being case reports or small case series from a single institution. Prior review attempts have not approached the literature in a systematic manner and have focused only on ICI-BP secondary to anti-programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PD-L1) therapy. The current knowledge base of all aspects of ICI-BP is limited.OBJECTIVE To characterize the risk factors, clinical presentation, diagnostic findings, treatments, and outcomes of ICI-BP in patients with cancer as reported in the current literature.EVIDENCE REVIEW A systematic review was performed using PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Articles reporting data on individual patients who met preestablished inclusion criteria were selected, and a predefined set of data was abstracted. When possible, study results were quantitatively combined.FINDINGS In total, 70 studies reporting data on 127 individual patients undergoing ICI therapy for cancer (median [IQR] age, 71 [64-77] years; 27 women [21.3%]) were included. In pooled analyses, patients ranged in age from 35 to 90 years. Immune checkpoint inhibitor-induced bullous pemphigoid often occurred during the course of anti-PD-1, PD-L1, or cytotoxic T lymphocyte-associated antigen 4 therapy but was also found to develop up to several months after treatment cessation. Prodromal symptoms, such as pruritus or nonspecific skin eruptions, were found in approximately half of the patient population. Histopathologic or serologic testing, when undertaken, was a helpful adjunct in establishing diagnosis. Treatment with immunotherapy was discontinued after ICI-BP development in most patients. The most common treatments were systemic and topical corticosteroids. Steroid-sparing therapies, such as antibiotics and other systemic immunomodulators, were also used as adjuvant treatment modalities. Biologic and targeted agents, used predominantly in cases refractory to treatment with corticosteroids, were associated with marked symptomatic improvement in most patients. CONCLUSIONS AND RELEVANCEThe results of this systematic review suggest that ICI-BP often poses a therapeutic challenge for patients with cancer who are receiving immunotherapy. Further research on the early recognition, diagnosis, and use of targeted treatment modalities will be essential in developing more personalized treatment options for affected patients while minimizing morbidity and mortality.

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Section: Resultsmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 99%

Association of Bullous Pemphigoid With Immune Checkpoint Inhibitor Therapy in Patients With Cancer

et al. 2022

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“…Rarely, but repeatedly, AIBS including BP arise in the course of PD1/PDL1 based ICB [24]. Reasons for that might include tumoral expression of BP180 leading to cross-reactivity [25]. Another hypothesis is that PD1 therapy might inhibit regulatory T cells to result in dysregulation of B cells with consecutive autoantibody production [24].…”

Section: Immune Checkpoint Blockade (Icb) and Autoimmune Blistering S...mentioning

confidence: 99%

Bullous Pemphigoid in Patients Receiving Immune-Checkpoint Inhibitors and Psoriatic Patients—Focus on Clinical and Histopathological Variation

et al. 2022

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Background: The most common autoimmune blistering disease, bullous pemphigoid (BP), shows an increased prevalence in psoriatic patients and oncologic patients undergoing immune-checkpoint blockade (ICB). Even though the same autoantigens (BP180/BP230) are detectable, it remains obscure whether clinical or histopathological differences exist between these different groups of BP patients. In this study, we strived to analyze this matter based on own data and previously published reports. Methods: We performed an institutional chart review from 2010–2020 to identify BP patients with psoriasis (n = 6) or underlying ICB (n = 4) and matched them with idiopathic cases of BP (n = 33). We compared clinical characteristics, subtypes, and dermatopathological determinants (e.g., tissue eosinophilia/neutrophilia, papillary edema, lymphocytic infiltration) among the groups. Results: ICB-associated BP affects men more often and might show mucosal involvement more frequently. We found no statistically significant dermatopathological differences among the groups. Conclusions: Clinicians should be aware of an increased risk of BP in patients with psoriasis and oncologic patients receiving ICB; atypical pruritic skin lesions should prompt a workup including a skin biopsy for histopathology and direct immunofluorescence in these patients. Larger studies might be necessary to detect slight dermatopathological variation.

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Metformin/sitagliptin/nivolumab/sitagliptin interaction

2020

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Immune checkpoint inhibitor–induced bullous pemphigoid: Towards a new class of drug-drug interaction?

Cited by 3 publications

References 9 publications

Association of Bullous Pemphigoid With Immune Checkpoint Inhibitor Therapy in Patients With Cancer

Association of Bullous Pemphigoid With Immune Checkpoint Inhibitor Therapy in Patients With Cancer

Bullous Pemphigoid in Patients Receiving Immune-Checkpoint Inhibitors and Psoriatic Patients—Focus on Clinical and Histopathological Variation

Metformin/sitagliptin/nivolumab/sitagliptin interaction

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