Pembrolizumab‐induced reactivation of bullous pemphigoid

Kaul, Subuhi; Wang, Allison; Grushchak, Solomiya; Albrecht, Joerg

doi:10.1111/ijd.15366

Cited by 5 publications

(4 citation statements)

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“…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%

“…78 Additional nonsteroid treatments were used in 50 patients (39.7%) and included antibiotics (eg, doxycycline, dapsone, minocycline, and niacinamide), antihistamines, and systemic immunomodulators, such as methotrexate, mycophenolate mofetil, and azathioprine. Biologic and targeted therapies, including infliximab (n = 1), 67 rituximab and intravenous immunoglobulin G (IVIG) (n = 2), 59,70 rituximab and plasma exchange (n = 1), 35 rituximab only (n = 7), 23,48,51,61,68,73,76 omalizumab (n = 3), 12,40 omalizumab and IVIG (n = 2), 78 IVIG only (1), 78 and dupilumab (n = 1) 65 were used by a small number of patients (18 of 127 [14.2%]), often in cases of ICI-BP that was refractory to systemic corticosteroids or those experiencing only partial symptomatic improvement.…”

Section: Management and Outcomesmentioning

confidence: 99%

“…Most patients experienced partial to complete improvement of BP with treatment (96 of 118 [81.4%]), although 4 patients (3.4%) 40,46,63 had ongoing pruritus despite resolution of their rash and 9 patients (7.6%) 18,24,34,37,41,42,53,61,72 required ongoing treatment with systemic steroids for effective symptomatic control. Among patients who received biologic therapy, 13 of 16 (81.3%) 12,23,35,40,48,51,65,67,68,70,73,78 had substantial improvement or resolution of their BP symptoms, whereas 3 (18.8%) had ongoing pruritus or continued skin involvement. 40,61,78 Although 1 previous study 80 found an association between the development of ICI-BP and improved cancer outcomes, there did not appear to be a marked pattern among published studies.…”

Section: Management and Outcomesmentioning

confidence: 99%

“…Most of these patients (26 [83.9%]) received systemic corticosteroids as a first-line treatment while only 19 (61.3%) and 3 patients (9.7%) received topical corticosteroids and biologics, respectively. Although data on survival were scarcely reported, all 9 patients who died because of cancer progression 9,15,17,49,60,66,68,74,78 had received systemic corticosteroids as a treatment for ICI-BP. Among patients who developed immunotherapy-related vitiligo before or after ICI-BP, 5 of 6 patients (83.3%) 10,15,18,63,65 with reported tumor outcomes experienced a complete response or stable disease, whereas only 1 patient 70 experienced disease progression.…”

Section: Management and Outcomesmentioning

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: 99%