Efficacy of Plasmapheresis in Nivolumab-Associated ANCA Glomerulonephritis: A Case Report and Pathophysiology Discussion

Laamech, Reda; Terrec, Florian; Emprou, C.; Toffart, Anne Claire; Pierret, Thomas; Naciri-Bennani, Hamza; Rostaing, Lionel; Noble, Johan

doi:10.1159/000518304

Cited by 8 publications

(3 citation statements)

References 25 publications

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“…Vasculitis caused by ICIs usually requires high-dose glucocorticoid treatment [ 77 ]. Other therapeutic options include cyclophosphamide [ 138 ], tocilizumab [ 119 ], rituximab [ 139 , 140 ], plasmapheresis [ 141 ], and JAK inhibitors [ 142 , 143 ]; however, the optimal management of ICI-induced vasculitis has not been established.…”

Section: Rheumatic Iraesmentioning

confidence: 99%

Rheumatic Immune-Related Adverse Events due to Immune Checkpoint Inhibitors—A 2023 Update

Dang¹,

Watanabe²,

Shiomi³

et al. 2023

IJMS

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With the aging of the population, malignancies are becoming common complications in patients with rheumatoid arthritis (RA), particularly in elderly patients. Such malignancies often interfere with RA treatment. Among several therapeutic agents, immune checkpoint inhibitors (ICIs) which antagonize immunological brakes on T lymphocytes have emerged as a promising treatment option for a variety of malignancies. In parallel, evidence has accumulated that ICIs are associated with numerous immune-related adverse events (irAEs), such as hypophysitis, myocarditis, pneumonitis, and colitis. Moreover, ICIs not only exacerbate pre-existing autoimmune diseases, but also cause de novo rheumatic disease–like symptoms, such as arthritis, myositis, and vasculitis, which are currently termed rheumatic irAEs. Rheumatic irAEs differ from classical rheumatic diseases in multiple aspects, and treatment should be individualized based on the severity. Close collaboration with oncologists is critical for preventing irreversible organ damage. This review summarizes the current evidence regarding the mechanisms and management of rheumatic irAEs with focus on arthritis, myositis, and vasculitis. Based on these findings, potential therapeutic strategies against rheumatic irAEs are discussed.

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Section: Rheumatic Iraesmentioning

confidence: 99%

Rheumatic Immune-Related Adverse Events due to Immune Checkpoint Inhibitors—A 2023 Update

Dang¹,

Watanabe²,

Shiomi³

et al. 2023

IJMS

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“…Laamech et al . report the case of an 81-year-old with non-small cell lung cancer treated with nivolumab who developed pulmonary hemorrhage and crescentic glomerulonephritis 3 weeks after his last dose of nivolumab [ 70 ]. He was myeloperoxidase (MPO) antibody positive and initially treated with pulse methylprednisolone and rituximab without renal response and ultimately required renal replacement therapy (RRT).…”

Section: Potential Indications For Plexmentioning

confidence: 99%

Plasma exchange for severe immune-related adverse events from checkpoint inhibitors: an early window of opportunity?

Katsumoto

Wilson

Giri

et al. 2022

Immunotherapy Advances

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Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of several advanced malignancies leading to durable remission in a subset of patients. Their rapidly expanding use has led to an increased frequency of immune-related adverse events (irAEs). The pathogenesis of irAEs is poorly understood but may involve aberrant activation of T cells leading to inflammatory cytokine release or production of pathogenic antibodies leading to organ damage. Severe irAEs can be extremely debilitating and, in some cases, life threatening. IrAEs may not always be corticosteroid responsive or may require excessively high, often toxic, corticosteroid doses. Therapeutic plasma exchange (PLEX) is a treatment modality that has shown promising results for the management of certain severe irAEs, including irAEs that are not mentioned in current treatment guidelines. PLEX may attenuate ongoing irAEs and prevent delayed irAEs by accelerating clearance of the ICI, or by acutely removing pathogenic antibodies, cytokines, and chemokines. Here, we summarize examples from the literature in which PLEX was successfully used for the treatment of irAEs. We posit that timing may be a critical factor and that earlier utilization of PLEX for life-threatening irAEs may result in more favorable outcomes. In individuals at high risk for irAEs, the availability of PLEX as a potential therapeutic mitigation strategy may encourage life-saving ICI use or rechallenge. Future research will be critical to better define which indications are most amenable to PLEX, particularly to establish the optimal place in the sequence of irAE therapies and to assess the ramifications of ICI removal on cancer outcomes.

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“…There are four studies with six patients reporting the use of TPE for renal irAEs, including acute renal failure, glomerulonephritis, renal vasculitis, and Goodpasture's disease. 36,[111][112][113] The average number of TPE procedures was 6 ± 4 (range 2-12). All patients received steroids.…”

Section: Tpe In the Treatment Of Renal Iraesmentioning

confidence: 99%

Therapeutic plasma exchange in the management of immune checkpoint inhibitor‐associated immune‐related adverse effects: A review

et al. 2022

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Efficacy of Plasmapheresis in Nivolumab-Associated ANCA Glomerulonephritis: A Case Report and Pathophysiology Discussion

Cited by 8 publications

References 25 publications

Rheumatic Immune-Related Adverse Events due to Immune Checkpoint Inhibitors—A 2023 Update

Rheumatic Immune-Related Adverse Events due to Immune Checkpoint Inhibitors—A 2023 Update

Plasma exchange for severe immune-related adverse events from checkpoint inhibitors: an early window of opportunity?

Therapeutic plasma exchange in the management of immune checkpoint inhibitor‐associated immune‐related adverse effects: A review

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