背景:我们的研究旨在使用FAERS的数据调查免疫检查点抑制剂相关垂体炎(ICI-垂体炎)的患病率和人口统计学特征,并探讨影响预后的危险因素。
方法:在这项回顾性研究中,2007年1月1日至2022年12月31日期间,所有新诊断的与FDA批准的ICIs相关的垂体炎病例均使用FAERS进行累积.人口统计数据,包括年龄,性别,体重,病例的预后,在不同的免疫治疗亚组之间分析和比较ICIs诱导的其他共同发生的内分泌病变。
结果:ICI-垂体炎的报告频率为1.46%(2343/160089)。接受联合治疗的患者发生垂体炎的风险较高,与其他单一疗法相比,其次是抗CTLA-4剂(p<0.001)。男性受试者显示出较高的ICI垂体炎报告风险(p=0.015)。接受抗PD-1治疗或联合治疗的患者表现出更高的1型糖尿病发生率(抗PD-1与抗PD-L1vs.抗CTLA-4vs.联合治疗,4.2%vs.0.7%与0.3%与8.4%,p<0.001)。接受联合治疗的患者新发甲状腺疾病的发生率高于抗PD-1单药治疗(12.3%vs.8.4%,p=0.010)。老年,肺癌,肾癌与严重的临床结局呈正相关[>65岁,或1.042,95CI(1.022-1.063),p<0.001;肺癌,或1.400,95CI(1.019-1.923),p=0.038;肾癌,或1.667,95CI(1.153-2.412),p=0.007]。发现抗CTLA-4单药治疗是严重结局的保护因素[OR0.433,95CI(0.335-0.558),p<0.001]。女性性别和ICI相关糖尿病的共同发生表现出更低的死亡风险[女性,或0.571,95CI(0.361-0.903),p=0.017;糖尿病,或0.090,95CI(0.016-0.524),p=0.007]。
结论:ICI诱发的垂体炎是男性主导的IRAE,最常见于抗CTLA-4单药或联合治疗的患者。当患者年龄较大时,临床医生的意识至关重要,肺癌或肾癌发展为垂体炎,这表明临床结果不佳。女性性别,抗CTLA-4单药治疗和合并ICI相关糖尿病是预后不良的保护性危险因素.
BACKGROUND: Our study aimed to investigate the prevalence and demographic characteristics of immune checkpoint inhibitor-associated hypophysitis (ICI-hypophysitis) using data from the FAERS, and the risk factors of prognosis were explored.
METHODS: In this retrospective study, all cases of newly-diagnosed hypophysitis associated with FDA approved ICIs from 1st January 2007 to 31st December 2022 were accumulated using FAERS. Demographic data including age, sex, body weight, the prognosis of cases, and other co-occurred endocrinopathies induced by ICIs were analyzed and compared between different subgroups of immunotherapy.
RESULTS: The reporting frequency of ICI-hypophysitis was 1.46% (2343/160089). Patients on the combination therapy had higher risk of hypophysitis reporting, followed by anti-CTLA-4 agent compared with other monotherapies (p < 0.001). Male subjects displayed higher reporting risk of ICI-hypophysitis (p = 0.015). Patients on anti-PD-1 therapy or the combination therapy showed higher occurrence rate of type 1 diabetes (anti-PD-1 vs. anti-PD-L1 vs. anti-CTLA-4 vs. combination therapy, 4.2% vs. 0.7% vs. 0.3% vs. 8.4%, p < 0.001). The occurrence rate of new-onset thyroid diseases in patients receiving combination therapy was higher than anti-PD-1 monotherapy (12.3% vs. 8.4%, p = 0.010). Elder age, lung cancer, and renal cancer emerged to be positively associated with severe clinical outcomes [>65 years, OR 1.042, 95%CI (1.022-1.063), p < 0.001; lung cancer, OR 1.400, 95%CI (1.019-1.923), p = 0.038; renal cancer, OR 1.667, 95%CI (1.153-2.412), p = 0.007]. Anti-CTLA-4 monotherapy was discovered to be a protective factor of severe outcomes [OR 0.433, 95%CI (0.335-0.558), p < 0.001]. Female sex and co-occurrence of ICI-related diabetes exhibited lower risk of death [female, OR 0.571, 95%CI (0.361-0.903), p = 0.017; diabetes, OR 0.090, 95%CI (0.016-0.524), p = 0.007].
CONCLUSIONS: ICI-induced hypophysitis is male-predominant irAE, most commonly seen in patients on anti-CTLA-4 mono- or combination therapy. Awareness among clinicians is critical when patients with elder age, lung or renal cancer develop hypophysitis, which indicates poor clinical outcomes. Female sex, anti-CTLA-4 monotherapy and co-occurrence of ICI-related diabetes are protective risk factors for poor prognosis.