Infliximab for the treatment of patients with checkpoint inhibitor-associated acute tubular interstitial nephritis.
Infliximab for the treatment of patients with checkpoint inhibitor-associated acute tubular interstitial nephritis.
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DOI：
10.1080/2162402x.2021.1877415
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发表时间：
2021-02-02
期刊：
影响因子：
7.2
通讯作者：
Abudayyeh A
中科院分区：
文献类型：
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作者：
Lin JS;Mamlouk O;Selamet U;Tchakarov A;Glass WF;Sheth RA;Layman RM;Dadu R;Abdelwahab N;Abdelrahim M;Diab A;Yee C;Abudayyeh A
急性肾小管间质性肾炎（ATIN）是检查点抑制剂（CPI）诱导的急性肾损伤（AKI）患者最常报道的病理。糖皮质激素（GC）治疗和停用CPI是预防永久性肾功能障碍和透析的主要治疗方法。然而，只有不到50%的患者肾脏完全恢复，ATIN可能会复发。英夫利昔单抗在治疗其他免疫相关不良事件方面有效，但其用于治疗CPI-ATIN尚未得到很好的证实。我们报告了第一项回顾性研究，研究了英夫利昔单抗在实现CPI-ATIN患者持久和完全肾脏恢复方面的类固醇节约潜力。数据收集自经肾活检或临床诊断为ATIN的CPI-AKI患者的医疗记录，这些患者使用GC和英夫利昔单抗进行治疗。采用含英夫利昔单抗方案治疗10例CPI-ATIN患者。4例经GC治疗后复发的患者肾脏得到持久完全恢复，4例患者肾脏部分恢复，2例患者肾功能无改善。这是首个评估使用含有英夫利昔单抗的方案治疗复发性CPI-ATIN患者或初次治疗后未能达到完全缓解的患者的临床结果的研究。我们的数据表明，英夫利昔单抗可能是这类患者实现持久和完全肾脏恢复的一种治疗选择，并且在具有挑战性的CPI-ATIN病例中代表了一种潜在的类固醇节约策略。有必要进行严格的临床研究，以评估在CPI-ATIN患者中使用英夫利昔单抗的风险-收益分析。
Acute tubular interstitial nephritis (ATIN) is the most frequently reported pathology in patients with checkpoint inhibitor (CPI) induced acute kidney injury (AKI). Glucocorticoid (GC) therapy and discontinuation of CPI are the mainstay of treatment to prevent permanent renal dysfunction and dialysis. However, less than 50% of patients have complete kidney recovery and relapse of ATIN can occur. Infliximab is effective in treating other immune-related adverse events but its use for the treatment of CPI-ATIN is not well established. We report the first retrospective study examining the steroid-sparing potential of infliximab in achieving durable and complete renal recovery for patients with CPI-ATIN. Data were collected from medical records of patients diagnosed with CPI-AKI with a kidney biopsy or clinical diagnosis of ATIN that was managed with GC and infliximab. Infliximab-containing regimens were used to treat 10 patients with CPI-ATIN. Four patients relapsing after GC therapy achieved durable and complete renal recovery, four patients experienced partial renal recovery, and two patients showed no improvement in kidney function. This is the first study evaluating clinical outcomes using an infliximab-containing regimen for treatment of relapsed CPI-ATIN in patients or patients failing to achieve complete response after primary therapy. Our data suggest that infliximab may be a treatment option for achieving durable and complete renal recovery in this patient population and represents a potential steroid-sparing strategy in challenging cases of CPI-ATIN. Rigorous clinical studies are warranted to evaluate the risk-benefit analysis for infliximab usage in CPI-ATIN patients.