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On 25 April, Yucai Wang from Mayo Clinic, Rochester, MN, USA, and colleagues, published in the Journal of the American Medical Association (JAMA) results from a systematic review and meta-analysis1 of adverse events (AEs) associated with the clinical use of programmed cell death ligand 1 (PD-L1) and PD-1 inhibitors.
PD-1 and PD-L1 inhibitors has been widely used to treat various types of cancers, with nivolumab and pembrolizumab (anti-PD-1), as well as atezolizumab, avelumab, and durvalumab (anti-PD-L1) having been approved by the Food and Drug Administration (FDA) for different indications2. Given the widespread use of such inhibitors against cancer, the authors sought to evaluate their safety profile among different pathologies from published clinical trials.
Any grade AE |
Incidence |
95% CI |
---|---|---|
Fatigue |
18.26% |
16.49−20.11 |
Pruritus |
10.61% |
9.46−11.83 |
Diarrhea |
9.47% |
8.43−10.58 |
Grade ≥ 3 AE |
Incidence |
95% CI |
Fatigue |
0.89% |
0.69−1.14 |
Anemia |
0.78% |
0.59−1.02 |
Aspartate aminotransferase (AST) increase |
0.75% |
0.56−0.99 |
Any grade endocrine irAEs |
Incidence |
95% CI |
---|---|---|
Hypothyroidism |
6.07% |
5.35−6.85 |
Hyperthyroidism |
2.82% |
2.40−3.29 |
Hyperglycemia |
1.20% |
0.91−1.55 |
Thyroiditis |
0.75% |
0.52−1.04 |
Adrenal insufficiency |
0.69% |
0.50−0.93 |
Grade ≥ 3 endocrine irAEs |
Incidence |
95% CI |
Hyperglycemia |
0.24% |
0.13−0.38 |
Adrenal insufficiency |
0.18% |
0.10−0.30 |
Type I diabetes |
0.18% |
0.10−0.30 |
Hypohysitis |
0.16% |
0.09−0.27 |
Hypothyroidism |
0.08% |
0.04−0.13 |
Any grade other irAEs |
Incidence |
95% CI |
---|---|---|
Diarrhea |
9.47% |
8.43−10.58 |
AST increase |
3.39% |
2.94−3.89 |
Vitiligo |
3.26% |
2.80−3.79 |
Alanine aminotransferase (ALT) increase |
3.14% |
2.71−3.62 |
Pneumonitis |
2.79% |
2.39−3.23 |
Colitis |
1.24% |
0.99−1.54 |
Grade ≥ 3 other irAEs |
Incidence |
95% CI |
AST increase |
0.75% |
0.56−0.99 |
ALT increase |
0.70% |
0.52−0.93 |
Pneumonitis |
0.67% |
0.50−0.89 |
Diarrhea |
0.59% |
0.45−0.77 |
Colitis |
0.47% |
0.34−0.65 |
This meta-analysis has identified the most common AEs occurring with PD-1 and PD-L1 inhibitors when used for the treatment of various types of cancers in clinical trials. This systematic analysis will aid in the future management of such treatments and provides a useful tool for clinicians.
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