Uveitis in Patients Treated with CTLA-4 and PD-1 Checkpoint Blockade Inhibition

Michel M. Sun; Ralph D. Levinson; Artur Filipowicz; Stephen Anesi; Henry J. Kaplan; Wei Wang; Debra A. Goldstein; Sapna Gangaputra; Robert T. Swan; H. Nida Sen; Lynn K. Gordon

doi:10.1080/09273948.2019.1577978

Uveitis in Patients Treated with CTLA-4 and PD-1 Checkpoint Blockade Inhibition

Michel M. Sun^*, Ralph D. Levinson, Artur Filipowicz, Stephen Anesi, Henry J. Kaplan, Wei Wang, Debra A. Goldstein, Sapna Gangaputra, Robert T. Swan, H. Nida Sen, Lynn K. Gordon

^*Corresponding author for this work

Ophthalmology

Research output: Contribution to journal › Article › peer-review

69 Scopus citations

Abstract

Purpose: To investigate the link between treatment with CTLA-4 and PD-1 checkpoint blockade inhibitors and the development of noninfectious uveitis. Methods: A survey was distributed to uveitis specialists to identify patients who developed uveitis while receiving either PD-1 inhibitors pembrolizumab and nivolumab; PD-L1 inhibitors atezolizumab, avelumab, and durvalumab; or the CTLA-4 inhibitor ipilimumab. Results: Fifteen patients from seven institutions were identified. The most common cancer diagnosis (13/15) was malignant melanoma. Fourteen patients had a new uveitis diagnosis following checkpoint blockade administration (six anterior uveitis, six panuveitis, one posterior uveitis, one anterior/intermediate combined); one patient developed optic neuritis. Uveitis was diagnosed within 6 months after drug initiation for 11/12 patients (median 63 days). Corticosteroid treatment was effective for most patients, although two patients had permanent loss of vision. Conclusions: Patients on checkpoint inhibitor therapy should be educated to seek care if they develop ocular symptoms, and prompt referral to specialists should be incorporated into oncology protocols.

Original language	English (US)
Pages (from-to)	217-227
Number of pages	11
Journal	Ocular Immunology and Inflammation
Volume	28
Issue number	2
DOIs	https://doi.org/10.1080/09273948.2019.1577978
State	Published - Feb 17 2020

Funding

This work is supported by an Unrestricted Grant from Research to Prevent Blindness, Inc. to the Department of Ophthalmology at UCLA. The use of REDCap was supported by Clinical and Translational Science Institute [Grant UL1TR001881]; Dr. Sen’s work was supported by the National Eye Institute Intramural Research Program. This work is supported by an Unrestricted Grant from Research to Prevent Blindness, Inc. to the Department of Ophthalmology at UCLA. We acknowledge the CTSI Grant UL1TR001881 for providing the use of REDCap for data collection. Dr. Sen’s work was supported by the National Eye Institute Intramural Research Program. We acknowledge Osama Sabbagh for assistance editing the survey and Joshua Suelflow for assistance with the literature review for Table 4.

Keywords

CTLA-4
Checkpoint inhibitor
PD-1
immunotherapy
ocular inflammation
uveitis

ASJC Scopus subject areas

Immunology and Allergy
Ophthalmology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1080/09273948.2019.1577978

Cite this

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abstract = "Purpose: To investigate the link between treatment with CTLA-4 and PD-1 checkpoint blockade inhibitors and the development of noninfectious uveitis. Methods: A survey was distributed to uveitis specialists to identify patients who developed uveitis while receiving either PD-1 inhibitors pembrolizumab and nivolumab; PD-L1 inhibitors atezolizumab, avelumab, and durvalumab; or the CTLA-4 inhibitor ipilimumab. Results: Fifteen patients from seven institutions were identified. The most common cancer diagnosis (13/15) was malignant melanoma. Fourteen patients had a new uveitis diagnosis following checkpoint blockade administration (six anterior uveitis, six panuveitis, one posterior uveitis, one anterior/intermediate combined); one patient developed optic neuritis. Uveitis was diagnosed within 6 months after drug initiation for 11/12 patients (median 63 days). Corticosteroid treatment was effective for most patients, although two patients had permanent loss of vision. Conclusions: Patients on checkpoint inhibitor therapy should be educated to seek care if they develop ocular symptoms, and prompt referral to specialists should be incorporated into oncology protocols.",

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Uveitis in Patients Treated with CTLA-4 and PD-1 Checkpoint Blockade Inhibition

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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