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Clinical features, treatment, and outcome of nivolumab-induced cholangitis.
He, Yang; Fan, Zhiqiang; Sun, Wei; Ouyang, Linqi; Wang, Chunjiang.
Afiliação
  • He Y; Department of pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China.
  • Fan Z; College of Pharmacy, Changsha Medical University, Changsha, Hunan, China.
  • Sun W; Department of pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China.
  • Ouyang L; Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
  • Wang C; Department of pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China.
Immunopharmacol Immunotoxicol ; : 1-6, 2024 Sep 17.
Article em En | MEDLINE | ID: mdl-39245799
ABSTRACT

BACKGROUND:

Cholangitis is an uncommon and severe adverse reaction of nivolumab with unclear clinical features. The purpose of this study was to investigate the clinicopathological features, imaging, and treatment of nivolumab-induced cholangitis.

METHODS:

Case reports, case series, and clinical studies of nivolumab-induced cholangitis were retrospectively analyzed by searching Chinese and English databases from January 1, 2017 to December 31, 2023.

RESULTS:

Thirty-eight patients entered the study. The median number of cycles of cholangitis onset was seven cycles after administration (range 1, 28) and the median time was 11 days (range 78, 390). Abdominal pain (42.1%) and fever (18.4%) were the most important initial symptoms. Some patients (15.8%) showed elevated liver enzymes without any clinical symptoms. The median alkaline phosphatase level was 1721 IU/L (range 126, 9118), and the median γ-glutamyltranspeptidase level was 829 IU/L (range 104, 3442). Anti-nuclear antibodies, anti-mitochondrial antibodies, and IgG4 typically show negative results. Imaging shows extrahepatic bile duct and intrahepatic bile duct dilation, hypertrophy, and stenosis. Liver biopsy and biliary tract biopsy mainly found CD8 inflammatory cell infiltration. Systemic steroids (84.2%) and ursodeoxycholic acid (UDCA) (34.2%) were administered, and 24 patients (63.2%) had poor to moderate response to steroids. Thirty-one patients (81.6%) improved and seven patients (18.4%) did not improve.

CONCLUSIONS:

Clinicians must remain vigilant for patients experiencing cholestasis while on nivolumab and should assess for cholangitis and carry out appropriate imaging tests. Considering the excellent efficacy of UCDA in cholangitis, steroids combined with UDCA may be a viable treatment option in cases where steroids are ineffective for cholangitis.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Immunopharmacol Immunotoxicol Assunto da revista: ALERGIA E IMUNOLOGIA / FARMACOLOGIA / TOXICOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: China

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Immunopharmacol Immunotoxicol Assunto da revista: ALERGIA E IMUNOLOGIA / FARMACOLOGIA / TOXICOLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: China