- Title
- Systematic review with meta-analysis: effectiveness of anti-inflammatory therapy in immune checkpoint inhibitor-induced enterocolitis
- Creator
- Ibraheim, Hajir; Baillie, Samantha; Samaan, Mark A.; Abu-Sbeih, Hamzah; Wang, Yinghong; Talley, Nicholas J.; P. Jones, Michael P.; Powell, Nick
- Relation
- Alimentary Pharmacology & Therapeutics Vol. 52, Issue 9, p. 1432-1452
- Publisher Link
- http://dx.doi.org/10.1111/apt.15998
- Publisher
- Wiley-Blackwell
- Resource Type
- journal article
- Date
- 2020
- Description
- Background: Immune checkpoint inhibitors have revolutionised cancer treatment, but at the cost of off-target immune-mediated organ damage. This includes checkpoint inhibitor-induced enterocolitis which frequently requires hospitalisation and may be life-threatening. Empiric treatment typically includes corticosteroids and infliximab, although no large-scale studies have confirmed their effectiveness. Aim: To investigate the effectiveness of anti-inflammatory therapy in checkpoint inhibitor-induced enterocolitis Methods: We performed a systematic review and meta-analysis of studies reporting clinical outcomes of checkpoint inhibitor-induced enterocolitis in adult cancer patients treated with anti-inflammatory agents. We searched Medline, EMBASE, and the Cochrane library through April and extracted the proportion of patients responding to anti-inflammatory therapy. Variation in effect size was studied using a random-effects meta-regression analysis, with checkpoint inhibitor agent and tumour type as the variables. Results: Data were pooled from 1210 treated patients across 39 studies. Corticosteroids were effective in 59% (95% CI 54- 65) of patients, with response significantly more favourable in patients treated with anti-PD-1/L1 monotherapy, compared with anti-CTLA-4 containing regimens (78%, 95% CI 69-85 vs 56 %, 95% CI 49-63, P = 0.003), and more favourable in lung cancer patients compared with melanoma patients (88%, 95% CI 62-97 vs 55%, 95% CI 47-63, P = 0.04). Infliximab was effective in 81% (95% CI 73-87) of patients, and vedolizumab in 85% (95% CI 60-96). Conclusion: Corticosteroids, infliximab and vedolizumab, are effective in the treatment of checkpoint inhibitor-induced enterocolitis. Checkpoint inhibitor regimen and cancer type were significant moderators in response to corticosteroid therapy.
- Subject
- anti-inflammatory agents; antibodies; monoclonal; enterocolitis; immune checkpoint; cancer patient; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1445741
- Identifier
- uon:42657
- Identifier
- ISSN:0269-2813
- Language
- eng
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