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Immune-related adverse effects
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Immune-related adverse effects

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Contributors: Paritosh Prasad MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Monoclonal antibodies directed against immune checkpoint inhibitor proteins cytotoxic T-lymphocyte antigen-4 (such as ipilimumab and tremelimumab) and programmed cell death-1 (such as nivolumab and pembrolizumab) show promise in the management of melanoma and other cancers by enhancing the immune system. During therapy with these novel therapies, a unique set of adverse effects may develop called immune-related adverse events. These can be of varying degrees of severity and include the development of rashes (which can progress to life-threatening toxic epidermal necrolysis), colitis, hepatitis, hypophysitis, pancreatitis, iridocyclitis, lymphadenopathy, neuropathies, nephritis, and pneumonitis.

The frequency of each type of immune-related adverse effect varies with the immune checkpoint inhibitor used and the condition for which it is used. Use of programmed cell death-1 inhibitors (such as nivolumab and pembrolizumab) have a lower incidence of immune-related adverse effects compared to inhibitors of cytotoxic T-lymphocyte antigen 4 (such as ipilimumab and tremelimumab).

Codes

ICD10CM:
T50.905A – Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter

SNOMEDCT:
62014003 – Adverse reaction caused by drug

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Differential diagnosis includes infectious and inflammatory conditions involving the end-organ in question.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 12/13/2016
Last Updated: 12/13/2016
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Immune-related adverse effects
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Immune-related adverse effects : Diarrhea, Fatigue, Nausea, Rash, ipilimumab, Pruritus, pembrolizumab, nivolumab, atezolizumab
Copyright © 2018 VisualDx®. All rights reserved.