Oral beclomethasone dipropionate is an effective treatment for immune checkpoint inhibitor induced colitis.
Oral beclomethasone dipropionate is an effective treatment for immune checkpoint inhibitor induced colitis.
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口服倍替众倍肽是免疫检查点抑制剂诱导结肠炎的有效治疗方法。
DOI：
10.1136/jitc-2022-005490
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发表时间：
2022-09
影响因子：
10.9
通讯作者：
中科院分区：
文献类型：
--
作者：
全身性皮质类固醇是免疫检查点抑制剂诱导的结肠炎的主要治疗方法，但也与包括危及生命的感染在内的并发症有关。局部作用的口服皮质类固醇二丙酸倍氯米松(BD)是治疗轻至中度溃疡性结肠炎的有效药物，且副作用比全身皮质类固醇少。我们假设BD将是治疗CPI诱导的结肠炎的有效方法。我们对2017年11月至2020年10月期间在英国三个癌症中心接受BD治疗CPI诱导的结肠炎的所有患者进行了回顾性分析。所有患者均接受了内窥镜检查和活检。BD的初始方案是每天5毫克，连续28天。数据是从电子病历中收集的。在治疗开始后28天评估临床结果。对22例CPI性结肠炎患者(男14例，中位年龄为，年龄45~84岁)采用补肾活血汤治疗。在基线时，24小时内大便稀疏的中位数为6(不良事件的通用术语标准，CTCAE分级腹泻=2)。13名患者(59%)在开始BD前依赖全身皮质类固醇。基础乙状结肠镜检查显示中度炎症2例(9%)，轻度炎症9例(41%)，正常11例(50%)。20例(91%)有炎症组织病理学特征。所有22名患者(100%)对BD有临床反应，21名(95%)临床缓解，大便频率恢复到基线水平(CTCAE腹泻=0)。10名患者(45%)在停止BD后出现症状复发，其中一半在停止7天内复发。所有患者在重新启动BD时均恢复反应。在接受BD治疗的患者中没有不良事件的报道。外用BD是治疗结肠炎的全身免疫抑制治疗的另一种有吸引力的选择。在本研究中，对于全身糖皮质激素无效的CPI诱导的结肠炎，BD是有效和安全的诱导缓解。需要进一步的随机研究来证实这些发现并确定最佳给药方案。
Systemic corticosteroids are the mainstay of treatment for immune checkpoint inhibitor induced (CPI) colitis but are associated with complications including life-threatening infection. The topically acting oral corticosteroid beclomethasone dipropionate (BD) is an effective treatment for mild to moderate flares of ulcerative colitis, and has fewer side effects than systemic corticosteroids. We hypothesized that BD would be an effective treatment for CPI-induced colitis. We performed a retrospective analysis of all patients who started BD for CPI-induced colitis at three UK cancer centers between November 2017 and October 2020. All patients underwent endoscopic assessment and biopsy. The initial regimen of BD was 5 mg once daily for 28 days. Data were collected from electronic patient records. Clinical outcomes were assessed at 28 days after initiation of treatment. Twenty-two patients (14 male) with a median age of 64 (range 45–84) with CPI-induced colitis were treated with BD. At baseline, the median number of loose stools in a 24-hour period was six (common terminology criteria for adverse events, CTCAE grade diarrhea=2). Thirteen patients (59%) were dependent on systemic corticosteroids prior to starting BD. Baseline sigmoidoscopy showed moderate inflammation (Mayo Endoscopic Score (MES) = 2) in two patients (9%), mild inflammation (MES=1) in nine patients (41%) and normal findings (MES=0) in eleven patients (50%). Twenty patients (91%) had histopathological features of inflammation. All 22 patients (100%) had a clinical response to BD and 21 (95%) achieved clinical remission with a return to baseline stool frequency (CTCAE diarrhea=0). Ten patients (45%) had symptomatic relapse on cessation of BD, half within 7 days of stopping. All patients recaptured response on restarting BD. No adverse events were reported in patients treated with BD. Topical BD represents an appealing alternative option to systemic immunosuppressive treatments to treat colonic inflammation. In this study, BD was effective and safe at inducing remission in CPI-induced colitis, which was refractory to systemic corticosteroids. Further randomized studies are needed to confirm these findings and determine the optimum dosing regimen.
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影响因子：
10.9
作者：
Alexander JL;Ibraheim H;Sheth B;Little J;Khan MS;Richards C;Hunter N;Chauhan D;Ratnakumaran R;McHugh K;Pinato DJ;Nathan P;Choy J;Crusz SM;Furness A;Turajlic S;Pickering L;Larkin J;Teare JP;Papa S;Speight A;Sharma A;Powell N
通讯作者：
Powell N
影响因子：
158.5
作者：
Larkin, J.;Chiarion-Sileni, V.;Wolchok, J. D.
通讯作者：
Wolchok, J. D.
影响因子：
50.5
作者：
Chalabi, M.;Cardona, A.;Herrera, F. G.
通讯作者：
Herrera, F. G.
影响因子：
64.8
作者：
Herbst RS;Soria JC;Kowanetz M;Fine GD;Hamid O;Gordon MS;Sosman JA;McDermott DF;Powderly JD;Gettinger SN;Kohrt HE;Horn L;Lawrence DP;Rost S;Leabman M;Xiao Y;Mokatrin A;Koeppen H;Hegde PS;Mellman I;Chen DS;Hodi FS
通讯作者：
Hodi FS
影响因子：
10.9
作者：
Hughes, Michael S.;Molina, Gabriel E.;Dougan, Michael
通讯作者：
Dougan, Michael