Detailed study of ophthalmic immune-related adverse events (OirAEs), including determination of incidence and recurrence rates, is of integral importance in the evolving field of cancer immunotherapy to inform management and treatment guidelines.
Retrospective registry study SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Patients newly diagnosed with OirAEs between January 1, 2013 and December 31, 2017 in the American Academy of Ophthalmology’s IRIS® Registry.
Data were collected from electronic health records of IRIS Registry participating ophthalmology practices. Patients with select OirAEs were identified by ICD diagnosis codes. The primary exposure of interest was prior initiation of ICIs.
Incidence of OirAEs within 1 year following initiation of ICIs, including anti-PD-1 or anti-CTLA-4 therapy was determined. Incidence rate ratios (IRR) were derived by comparing incidence of OirAEs after ICIs versus rates of the same ocular complications in patients not taking ICIs in the entire registry population. Rates of OirAEs in patients with a past history of ocular inflammation or other specific ophthalmic condition prior to initiation of ICIs were further examined.
A total of 3,123 patients were identified to have received anti-CTLA-4, anti-PD-1, or anti-PD-L1 therapy, 112 of whom developed an OirAE. Incidence rates for anterior uveitis, the most common OirAE, were found to be 8,209 per 100,000 for ipilimumab (anti-CTLA-4), 2,542 per 100,000 for nivolumab (anti-PD-1), 2,451 per 100,000 for pembrolizumab (anti-PD-1), 5,556 per 100,000 for combination ipilimumab/nivolumab, and 3,740 per 100,000 among all ICIs. Rates of OirAEs among patients on ICI therapy were found to be much greater compared to baseline ocular complication rates in the general registry population (anterior uveitis incidence rate ratio [IRR] = 13.9, intermediate/posterior/panuveits IRR = 43.0, papilledema IRR = 38.3). Patients with a prior history of uveitis or other ocular inflammatory condition demonstrated high recurrence rates of OirAEs after initiating ICIs (51.1% for intermediate/posterior/panuveitis and 38.9% for anterior uveitis).
For patients initiating ICI therapy, early coordination with ophthalmic subspecialist care is important, as rates of OirAEs are elevated compared to ocular complication rates in the entire registry population and patients with a previous history of any uveitis or autoimmune ocular disease are at high risk of recurrence of ocular complication.
Copyright © 2020. Published by Elsevier Inc.