Aftermath of induced inflammation: acute periaortitis due to nivolumab therapy

Roy, Arindam; Tathireddy, Harsha; Roy, Moni

doi:10.1136/bcr-2017-221852

Cited by 22 publications

(11 citation statements)

References 4 publications

(1 reference statement)

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“…ICI-associated vasculitis can affect vessels of any size, [67][68][69][70][71][72][73] but has most commonly been reported in large vessels such as temporal (giant cell) arteritis and aortitis, according to a systematic review of case reports. 74 The over-representation of temporal arteritis reports among ICI users was also recently identified in a pharmacovigilance study.…”

Section: Ici-associated Vasculitismentioning

confidence: 99%

Cardiovascular toxicities associated with immune checkpoint inhibitors

Florido

Lipson

et al. 2019

Cardiovascular Research

345

300

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Cardiovascular toxicities associated with immune checkpoint inhibitors (ICIs) have been reported in case series but have been underappreciated due to their recent emergence, difficulties in diagnosis and non-specific clinical manifestations. ICIs are antibodies that block negative regulators of the T cell immune response, including cytotoxic T lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), and PD-1 ligand (PD-L1). While ICIs have introduced a significant mortality benefit in several cancer types, the augmented immune response has led to a range of immune-related toxicities, including cardiovascular toxicity. ICI-associated myocarditis often presents with arrhythmias, may co-exist with myositis and myasthenia gravis, can be severe, and portends a poor prognosis. In addition, pericardial disease, vasculitis, including temporal arteritis, and non-inflammatory heart failure, have been recently described as immune-related toxicities from ICI. This narrative review describes the epidemiology, diagnosis, pathophysiology, and treatment of cardiovascular toxicities of ICI therapy, highlighting recent developments in the field in the past year. Keywords Cardio-oncology • Immune checkpoint inhibitors • Myocarditis • Vasculitis • Pericarditis • Cardiovascular toxicity This article is part of the Spotlight Issue on Cardio-oncology.

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Section: Ici-associated Vasculitismentioning

confidence: 99%

Cardiovascular toxicities associated with immune checkpoint inhibitors

Florido

Lipson

et al. 2019

Cardiovascular Research

345

300

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“…The term "autoimmune vasculitis" has been used in the phase II study of ipilimumab [55]. Various forms of vasculitis affecting large vessels have been reported, and the corresponding diagnoses include GCA [33,56,57] or periaortitis [58]. Additionally, medium or small vessels can be affected, with cases of granulomatosis with polyangiitis (GPA) [59,60], eosinophilic granulomatosis with polyangiitis (EGPA) [61] and cryoglobulinemic vasculitis [62] having been reported.…”

Section: Vasculitismentioning

confidence: 99%

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Μελισσαρόπουλος

Klavdianou

Filippopoulou

et al. 2020

IJMS

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Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that activate the immune system, aiming at enhancing antitumor immunity. Their clinical efficacy is well-documented, but the side effects associated with their use are still under investigation. These drugs cause several immune-related adverse events (ir-AEs), some of which stand within the field of rheumatology. Herein, we present a literature review performed in an effort to evaluate all publicly available clinical data regarding rheumatic manifestations associated with ICIs. The most common musculoskeletal ir-AEs are inflammatory arthritis, polymyalgia rheumatica and myositis. Non-musculoskeletal rheumatic manifestations are less frequent, with the most prominent being sicca, vasculitides and sarcoidosis. Cases of systemic lupus erythematosus or scleroderma are extremely rare. The majority of musculoskeletal ir-AEs are of mild/moderate severity and can be managed with steroids with no need for ICI discontinuation. In severe cases, more intense immunosuppressive therapy and permanent ICI discontinuation may be employed. Oncologists should periodically screen patients receiving ICIs for new-onset inflammatory musculoskeletal complaints and seek a rheumatology consultation in cases of persisting symptoms.

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“…In contrast, patients treated with nivolumab were not receiving any concomitant medication, especially G-CSF, strengthening a causal relationship with aortitis. Of note, of the 6 aortitis ICSR associated with nivolumab and reported in VigiBase, 2 had also been reported in the literature 8,9 . For the 2 drugs likely to induce aortitis, G-CSF and nivolumab, time to onset was available in 12 and 3 patients, respectively 8,9 .…”

Section: Antineoplastic Drug-induced Aortitis: An Unraveled Adverse Effect Using the World Health Organization Pharmacovigilance Databasementioning

confidence: 90%

“…Of note, of the 6 aortitis ICSR associated with nivolumab and reported in VigiBase, 2 had also been reported in the literature 8,9 . For the 2 drugs likely to induce aortitis, G-CSF and nivolumab, time to onset was available in 12 and 3 patients, respectively 8,9 . In these patients, median time to aortitis onset was 8 days (range 3-34 days) and 285 days (range 275-305 days) after initial exposure to G-CSF and nivolumab, respectively.…”

Section: Antineoplastic Drug-induced Aortitis: An Unraveled Adverse Effect Using the World Health Organization Pharmacovigilance Databasementioning

confidence: 90%

Antineoplastic Drug-induced Aortitis: An Unraveled Adverse Effect Using the World Health Organization Pharmacovigilance Database

2020

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Aortitis is a rare inflammatory disease ranging from asymptomatic aortic thickening to life-threatening manifestations, especially aortic dissection or stenosis. Aortitis mainly occurs during systemic inflammatory diseases (giant cell arteritis, Takayasu arteritis, IgG4-related disease) and less frequently in patients with syphilis or tuberculosis1. Aortitis is rarely suspected to be induced by drugs and its causality is hardly assessable. The aim of our study is to identify drugs associated with aortitis occurrence using a data-mining approach.

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Aftermath of induced inflammation: acute periaortitis due to nivolumab therapy

Cited by 22 publications

References 4 publications

Cardiovascular toxicities associated with immune checkpoint inhibitors

Cardiovascular toxicities associated with immune checkpoint inhibitors

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Antineoplastic Drug-induced Aortitis: An Unraveled Adverse Effect Using the World Health Organization Pharmacovigilance Database

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