免疫检查点抑制剂相关的Vogt-Koyanagi-Harada类综合征:一个描述性的系统性审查
Huixin Anna Zhang1,2, Amelia T Yuan3, Noémie Chiasson4
1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
Journal of ophthalmic inflammation and infection
|May 12, 2025
概括
免疫检查点抑制剂 (ICI) 可能导致Vogt-Koyanagi-Harada (VKH) 类脑膜炎,特别是在用PD-1抑制剂治疗的黑色素瘤患者中. 虽然经常危及视力,但大多数患者在治疗后得到缓解,尽管ICI治疗可能会暂停.
科学领域:
- 眼科和瘤学 眼科和瘤学
- 免疫学和癌症治疗学
背景情况:
- 免疫检查点抑制剂 (ICI) 越来越多地用于癌症治疗.
- 眼部免疫相关的不良事件 (irAEs),如Vogt-Koyanagi-Harada (VKH) 类型的脑膜炎,是ICI治疗的新出现的并发症.
- 这些IRAE可能需要暂停治疗,并对视力构成风险.
研究的目的:
- 详细描述ICI治疗后出现VKH类脑膜炎的患者的并发症,眼部表现,治疗和视觉结果.
- 综合现有的关于这种罕见但重要的不良事件的文献.
主要方法:
- 根据PRISMA指南 (PROSPERO #CRD42024558269) 进行了一次系统审查.
- 搜索包括 MEDLINE,Embase,CENTRAL 和 Web of Science,截至 2024 年 6 月 28 日.
- 包括报告ICI治疗后出现VKH类脑膜炎的研究,无论设计如何;评估了偏差风险.
主要成果:
- 该审查包括42篇文章,包括52名患者,主要是接受PD-1抑制剂治疗的黑色素瘤女性.
- 在ICI治疗平均22.2周后发生了VKH类脑膜炎,通常呈现为双边脑膜炎.
- 大多数患者 (90.4%) 需要使用类固醇,59.6%的ICI治疗已经结束,82.7%的患者实现了视力缓解.
结论:
- 类似VKH的脑膜炎是与ICI治疗相关的显著的irAE,特别是黑色素瘤患者的PD-1抑制剂.
- 虽然潜在的视力威胁并导致治疗停止,但及时管理往往会导致有利的视觉结果.
- 瘤学家和眼科医生之间加强合作对于在癌症护理连续性范围内管理这些irAEs至关重要.
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