Abstract:
OBJECTIVES:To analyse the worldwide occurrence of sicca/Sjögren's (SS) syndrome associated with the use of immune checkpoint inhibitors (ICI) in patients with cancer. METHODS:The ImmunoCancer International Registry (ICIR) is a Big Data-Sharing multidisciplinary network composed by 40 specialists in Rheumatology, Internal Medicine, Immunology and Oncology from 18 countries focused on the clinical and basic research of the immune-related adverse events (irAEs) related to cancer immunotherapies. For this study, patients who were investigated for a clinical suspicion of SS after being exposed to ICI were included. RESULTS:We identified 26 patients (11 women and 15 men, with a mean age at diagnosis of 63.57 years). Underlying cancer included lung (n=12), renal (n=7), melanoma (n=4), and other (n=3) neoplasia. Cancer immunotherapies consisted of monotherapy (77%) and combined regimens (23%). In those patients receiving monotherapy, all patients were treated with PD-1/PD-L1 inhibitors (nivolumab in 9, pembrolizumab in 7 and durvalumab in 4); no cases associated with CTLA-4 inhibitors were identified. The main SS-related features consisted of dry mouth in 25 (96%) patients, dry eye in 17 (65%), abnormal ocular tests in 10/16 (62%) and abnormal oral diagnostic tests in 12/14 (86%) patients. Minor salivary gland biopsy was carried out in 15 patients: histopathological findings consisted of mild chronic sialadenitis in 8 (53%) patients and focal lymphocytic sialadenitis in the remaining 7 (47%); a focus score was measured in 5 of the 6 patients (mean of 1.8, range 1-4). Immunological markers included positive ANA in 13/25 (52%), anti-Ro/ SS-A in 5/25 (20%), RF in 2/22 (9%), anti-La/SS-B in 2/25 (8%), low C3/C4 levels in 1/17 (6%) and positive cryoglobulins in 1/10 (10%). Classification criteria for SS were fulfilled by 10 (62%) out of 16 patients in whom the two key classificatory features were carried out. Among the 26 patients, there were only 3 (11%) who presented exclusively with sicca syndrome without organ-specific autoimmune manifestations. Therapeutic management included measures directed to treat sicca symptoms and therapies against autoimmune-mediated manifestations (glucocorticoids in 42%, second/third-line therapies in 31%); therapeutic response for systemic features was observed in 8/11 (73%). No patient died due to autoimmune involvement. CONCLUSIONS:Patients with Sjögren's syndrome triggered by ICI display a very specific profile different from that reported in idiopathic primary SS, including more frequent occurrence in men, a higher mean age, a predominant immunonegative serological profile, and a notable development of organ-specific autoimmune involvement in spite of the poor immunological profile. The close association found between sicca/Sjögren's syndrome and primarily PD-1 blockade requires further specific investigation.
journal_name
Clin Exp Rheumatoljournal_title
Clinical and experimental rheumatologyauthors
Ramos-Casals M,Maria A,Suárez-Almazor ME,Lambotte O,Fisher BA,Hernández-Molina G,Guilpain P,Pundole X,Flores-Chávez A,Baldini C,Bingham Iii CO,Brito-Zerón P,Gottenberg JE,Kostine M,Radstake TRD,Schaeverbeke T,Schulze-Koopsubject
Has Abstractpub_date
2019-05-01 00:00:00pages
114-122issue
3eissn
0392-856Xissn
1593-098Xpii
14290journal_volume
37 Suppl 118pub_type
杂志文章abstract::It is recognised that the genetic profiles that give rise to chronic inflammatory diseases, under the influence of environmental agents, might have been implicated in the host defence mechanism against lethal infections in the past. Behçet's disease (BD) is an immune-mediated inflammatory disease, expressed as vasculi...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,评审
doi:
更新日期:2014-07-01 00:00:00
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journal_title:Clinical and experimental rheumatology
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journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,多中心研究
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abstract::This review considers the epidemiological aspects of the genetic investigation of rheumatoid arthritis (RA). Problems both of disease definition and disease heterogeneity render studies difficult to undertake and interpret. The selection of individuals both in population and family studies can explain divergent result...
journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,评审
doi:
更新日期:1992-05-01 00:00:00
abstract::Behçet's syndrome is a chronic multisystem inflammatory disease characterised classically by recurrent oral and genital ulcers with ocular lesions. It can affect blood vessels of all sizes, but involves veins more commonly than arterie. The presence of chylothorax in Behçet's syndrome is rare, with only a few cases ci...
journal_title:Clinical and experimental rheumatology
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doi:
更新日期:2011-07-01 00:00:00
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journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,多中心研究
doi:
更新日期:2012-01-01 00:00:00
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journal_title:Clinical and experimental rheumatology
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更新日期:2007-07-01 00:00:00
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journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
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更新日期:2004-03-01 00:00:00
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journal_title:Clinical and experimental rheumatology
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journal_title:Clinical and experimental rheumatology
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journal_title:Clinical and experimental rheumatology
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journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章,评审
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journal_title:Clinical and experimental rheumatology
pub_type: 杂志文章
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journal_title:Clinical and experimental rheumatology
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journal_title:Clinical and experimental rheumatology
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journal_title:Clinical and experimental rheumatology
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journal_title:Clinical and experimental rheumatology
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journal_title:Clinical and experimental rheumatology
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journal_title:Clinical and experimental rheumatology
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journal_title:Clinical and experimental rheumatology
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