免疫检查点抑制剂诱导糖尿病的鉴定
Karina N Ruiz-Esteves1, Kaitlyn R Shank2, Aaron J Deutsch3,4
1Department of Medicine, Massachusetts General Hospital, Boston, MA and Harvard Medical School, Boston.
JAMA oncology
|August 29, 2024
概括
免疫检查点抑制剂 (ICI) 治疗可以导致糖尿病,一种严重的免疫相关不良事件 (irAE). 以前存在的2型糖尿病和ICI组合治疗是危险因素,遗传倾向也起着作用.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 内分泌学 在内分泌学.
背景情况:
- 免疫检查点抑制剂 (ICI) 已经改变了癌症治疗,但可能导致与免疫相关的不良事件 (irAEs).
- 危及生命的irrAEs可能需要停止ICI治疗,即使瘤反应是积极的.
- 定义iRAE的频谱对于个性化ICI治疗决策至关重要.
研究的目的:
- 为了确定ICI诱导糖尿病的发病率,风险因素和临床特征,一个严重的irAE.
- 调查遗传倾向与患ICI诱导糖尿病的风险之间的关联.
主要方法:
- 一项对14328名成年患者的队列研究,在2010年7月至2022年1月期间接受ICI治疗.
- 手动确认ICI诱导的糖尿病病例,在诊断时进行详细的临床表型和1年的随访.
- 862名患者的1型糖尿病 (T1D GRS2) 多基因风险评分的基因定型和计算.
主要成果:
- ICI诱导糖尿病的患病率为0.45% (64/14,328名患者).
- 重要风险因素包括先前存在的2型糖尿病 (OR,5.91) 和ICI组合治疗 (OR,2.57).
- 较高的T1D GRS2与ICI诱导的糖尿病风险增加有关 (OR,4.4),表明自身免疫和irAEs之间存在遗传联系.
结论:
- 由ICI诱导的糖尿病是具有可识别的临床和遗传风险因素的显著irrAE.
- 患有ICI诱导糖尿病的患者呈现出不同的表型.
- 了解这些因素可以改善ICI诱导糖尿病和其他IRAE的诊断和管理,因为ICI的使用正在扩大.
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