Michel M Sun1, Ralph D Levinson1, Artur Filipowicz2, Stephen Anesi2, Henry J Kaplan3, Wei Wang3, Debra A Goldstein4, Sapna Gangaputra5, Robert T Swan6, H Nida Sen7, Lynn K Gordon1. 1. Department of Ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA. 2. Department of Ophthalmology, Massachusetts Eye Research and Surgical Institution, Waltham, MA, USA. 3. Department of Ophthalmology, University of Louisville, Louisville, KY, USA. 4. Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 5. Department of Ophthalmology, Vanderbilt Eye Institute, Nashville, TN, USA. 6. Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, NY, USA. 7. National Eye Institute, NIH, Bethesda, MD, USA.
Abstract
Purpose: To investigate the link between treatment with CTLA-4 and PD-1 checkpoint blockade inhibitors and the development of noninfectious uveitis. Methods: A survey was distributed to uveitis specialists to identify patients who developed uveitis while receiving either PD-1 inhibitors pembrolizumab and nivolumab; PD-L1 inhibitors atezolizumab, avelumab, and durvalumab; or the CTLA-4 inhibitor ipilimumab. Results: Fifteen patients from seven institutions were identified. The most common cancer diagnosis (13/15) was malignant melanoma. Fourteen patients had a new uveitis diagnosis following checkpoint blockade administration (six anterior uveitis, six panuveitis, one posterior uveitis, one anterior/intermediate combined); one patient developed optic neuritis. Uveitis was diagnosed within 6 months after drug initiation for 11/12 patients (median 63 days). Corticosteroid treatment was effective for most patients, although two patients had permanent loss of vision.Conclusions: Patients on checkpoint inhibitor therapy should be educated to seek care if they develop ocular symptoms, and prompt referral to specialists should be incorporated into oncology protocols.
Purpose: To investigate the link between treatment with CTLA-4 and PD-1 checkpoint blockade inhibitors and the development of noninfectious uveitis. Methods: A survey was distributed to uveitis specialists to identify patients who developed uveitis while receiving either PD-1 inhibitors pembrolizumab and nivolumab; PD-L1 inhibitors atezolizumab, avelumab, and durvalumab; or the CTLA-4 inhibitor ipilimumab. Results: Fifteen patients from seven institutions were identified. The most common cancer diagnosis (13/15) was malignant melanoma. Fourteen patients had a new uveitis diagnosis following checkpoint blockade administration (six anterior uveitis, six panuveitis, one posterior uveitis, one anterior/intermediate combined); one patient developed optic neuritis. Uveitis was diagnosed within 6 months after drug initiation for 11/12 patients (median 63 days). Corticosteroid treatment was effective for most patients, although two patients had permanent loss of vision.Conclusions: Patients on checkpoint inhibitor therapy should be educated to seek care if they develop ocular symptoms, and prompt referral to specialists should be incorporated into oncology protocols.
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