Evaluation of anidulafungin in the treatment of intra-abdominal candidiasis: a pooled analysis of patient-level data from 5 prospective studies.

Eur J Clin Microbiol Infect Dis. 2019 Oct;38(10):1849-1856

Authors: Sganga G, Wang M, Capparella MR, Tawadrous M, Yan JL, Aram JA, Montravers P

Abstract
The incidence of nosocomial invasive fungal infections involving Candida spp. has increased markedly in recent years in patients undergoing abdominal surgery. This post hoc analysis aimed to determine the efficacy and safety of anidulafungin treatment in patients with intra-abdominal candidiasis (IAC) from five prospective studies (one comparative and four open-label) of adult surgical patients with microbiologically confirmed Candida intra-abdominal infection. Patients received an intravenous (IV) loading dose of anidulafungin 200 mg, followed by a daily 100-mg maintenance dose. Per study protocols, some patients could be switched to an oral azole after ≥ 5 or ≥ 10 days of IV treatment. Antifungal treatment was maintained for ≥ 14 days after the last positive Candida culture and resolution of symptoms. The global response rate (GRR) at the end of IV treatment (EOIVT) was the primary endpoint. GRR at the end of therapy (EOT), all-cause mortality at days 14 and 28, and safety was also evaluated. Seventy-nine patients had IAC from peritoneal fluid or hepatobiliary tract. C. albicans (72.2%) and C. glabrata (32.9%) were the most common pathogens. Overall GRR was 73.4% and 67.1% at EOIVT and EOT, respectively. All-cause mortality was 17.7% at day 14 and 24.1% at day 28 in the modified intent-to-treat population. Anidulafungin was well tolerated in this population, with most adverse events mild or moderate in severity. In these patients with IAC, anidulafungin showed a GRR at EOIVT similar to the anidulafungin registrational trial, and the results of our analysis confirmed the known safety profile of anidulafungin. ClinicalTrials.gov registration number NCT00496197, registered July 3, 2007, https://clinicaltrials.gov/ct2/show/study/NCT00496197 ; ClinicalTrials.gov registration number NCT00548262, registered October 19, 2007, https://clinicaltrials.gov/ct2/show/record/NCT00548262 ; ClinicalTrials.gov registration number NCT00537329, registered September 25, 2007, https://clinicaltrials.gov/ct2/show/record/NCT00537329 ; ClinicalTrials.gov registration number NCT00689338, registered May 29, 2008, https://clinicaltrials.gov/ct2/show/study/NCT00689338 ; ClinicalTrials.gov registration number NCT00805740, registered November 26, 2008, https://clinicaltrials.gov/ct2/show/NCT00805740.

PMID: 31280481 [PubMed - indexed for MEDLINE]

Elaboration and validation of a drug administration checklist for patients in research protocols.

Rev Gaucha Enferm. 2019;40(spe):e20180311

Authors: Cardoso ASF, Muller S, Echer IC, Rabelo-Silva ER, Boni FG, Ribeiro AS

Abstract
OBJECTIVE: To describe the elaboration and validation of a checklist as a strategy for safe drug administration.
METHOD: It is a Validation study by consensus of experts conducted from January to June 2018, in a Clinical Research Center of a university hospital. The checklist was validated by three nurses, two nursing technicians, a pharmacist, two nurse teachers and one medical teacher, all with extensive experience in drug administration and in clinical research. For the final version of the checklist, a consensus of 100% was considered.
RESULTS: A guide was prepared consisting of six items to be checked by the care team before, during and after administration of Clinical Research drugs.
CONCLUSION: The validation of the checklist provided guiding elements for the prevention of behaviors that could lead to the risk of adverse events and also allowed the care teams to seek safe strategies of care in drug administration.

PMID: 31038601 [PubMed - indexed for MEDLINE]

Lamotrigine drug interactions in combination therapy and the influence of therapeutic drug monitoring on clinical outcomes in paediatric patients.

Basic Clin Pharmacol Toxicol. 2019 Jul;125(1):26-33

Authors: Koristkova B, Grundmann M, Brozmanova H, Kacirova I

Abstract
The aim was to study the impact of therapeutic drug monitoring (TDM) on paediatric patients on lamotrigine therapy and the evaluation of possible drug interactions, especially in triple antiepileptic drug combinations. During the period of 2001-2015, 1308 pre-dose samples were taken from 430 patients <15 years of age as part of routine TDM. Drug interactions were evaluated using calculation of lamotrigine clearance. Valproic acid decreased lamotrigine clearance by 54% in bitherapy, and by 21% in triple therapy with carbamazepine. Carbamazepine increased lamotrigine clearance by 191% in bitherapy. Levetiracetam and topiramate had no effect. The upper limit of lamotrigine therapeutic range (TR) was exceeded in 2% of cases in monotherapy, and in 6%-7% of cases in bi- or triple therapy. About 61% of plasma levels were found within the TR during 2001-2005, compared to 75% and 74% during 2006-2010 and 2011-2015, respectively. Adverse drug reactions (ADRs) were reported in 22 cases. Higher number of supratherapeutic levels in combination therapy led to a 3-fold increase in incidence of ADRs. Seizures occurred more often daily and monthly during 2001-2005 and in patients with three or four antiepileptic drugs in combination. Carbamazepine only partially compensated for the inhibitory effect of valproic acid. Lamotrigine clearance in monotherapy in children is similar to adults, but in polytherapy was found higher susceptibility to induction. A significantly higher number of supratherapeutic lamotrigine levels were found in combinations with valproate. Despite poor correlation with TR, both seizure frequency and ADRs declined after the implementation of TDM.

PMID: 30681278 [PubMed - indexed for MEDLINE]

Fosfomycin in severe infections due to genetically distinct pan-drug-resistant Gram-negative microorganisms: synergy with meropenem.

J Antimicrob Chemother. 2019 01 01;74(1):177-181

Authors: Perdigão Neto LV, Oliveira MS, Martins RCR, Marchi AP, Gaudereto JJ, da Costa LATJ, de Lima LFA, Takeda CFV, Costa SF, Levin AS

Abstract
Background: In vitro and clinical studies using parenteral fosfomycin have suggested the possibility of using this drug against infections caused by MDR microorganisms. The aim of this study was to describe a case series of patients treated with fosfomycin who had severe infections caused by pan-drug-resistant Gram-negative bacteria.
Methods: We describe a prospective series of cases of hospitalized patients with infections caused by Gram-negative bacteria resistant to β-lactams and colistin, treated with 16 g of fosfomycin daily for 10-14 days. Isolates were tested for antimicrobial susceptibility and synergism of fosfomycin with meropenem. We tested for resistance genes and performed typing using PCR and WGS.
Results: Thirteen patients received fosfomycin (seven immunosuppressed); they had bloodstream infections (n = 11; 85%), ventilator-associated pneumonia (n = 1; 8%) and surgical site infection (n = 1; 8%), caused by Klebsiella pneumoniae (n = 9), Serratia marcescens (n = 3) and Pseudomonas aeruginosa (n = 1). Overall, eight (62%) patients were cured. Using time-kill assays, synergism between fosfomycin and meropenem occurred in 9 (82%) of 11 isolates. Typing demonstrated that K. pneumoniae were polyclonal. Eight patients (62%) had possible adverse events, but therapy was not discontinued.
Conclusions: Fosfomycin may be safe and effective against infections caused by pan-drug-resistant Gram-negative microorganisms with different antimicrobial resistance mechanisms and there seems to be synergism with meropenem.

PMID: 30376073 [PubMed - indexed for MEDLINE]

Pharmacokinetics of dolutegravir with and without darunavir/cobicistat in healthy volunteers.

J Antimicrob Chemother. 2019 01 01;74(1):149-156

Authors: Elliot ER, Cerrone M, Else L, Amara A, Bisdomini E, Khoo S, Owen A, Boffito M

Abstract
Background: Dolutegravir combined with darunavir/cobicistat is a promising NRTI-sparing and/or salvage strategy for the treatment of HIV-1 infection.
Methods: This Phase I, open-label, 57 day, crossover, pharmacokinetic (PK) study, enrolled healthy volunteers aged 18-65 years, who were randomized to one of two groups. Group 1 received dolutegravir (50 mg) once daily for 14 days followed by a 7 day washout, then a 14 day dolutegravir/darunavir/cobicistat (DTG/DRV/COBI) once-daily co-administration period followed by a 7 day washout and finally a 14 day period of darunavir/cobicistat (800/150 mg) once daily. Group 2 followed the same sequence starting with darunavir/cobicistat and concluding with dolutegravir. Each group underwent intensive PK sampling over 24 h on day 14 of each drug period and DTG/DRV/COBI concentrations were measured using validated LC-MS/MS methods.
Results: Twenty participants completed all PK phases. Thirteen were female and median age and BMI were 33.5 years and 27 kg/m2. Dolutegravir geometric mean ratios (GMR, DTG/DRV/COBI versus dolutegravir alone) and 90% CI for Cmax, AUC0-24 and C24 were 1.01 (0.92-1.11), 0.95 (0.87-1.04) and 0.9 (0.8-1.0), respectively. Darunavir GMR (DRV/COBI/DTG versus darunavir/cobicistat alone) and 90% CI for Cmax, AUC0-24 and C24 were 0.90 (0.83-0.98), 0.93 (0.86-1.00) and 0.93 (0.78-1.11), respectively. No grade 3 or 4 adverse events or laboratory abnormalities were observed.
Conclusions: Concentrations of dolutegravir and darunavir, when boosted with cobicistat, decreased by <10% during co-administration, suggesting this combination can be prescribed safely in the treatment of HIV-1, with no adjustment to current guideline-recommended dosages.

PMID: 30272231 [PubMed - indexed for MEDLINE]

Gabapentin for Pain Management after Osmotic Dilator Insertion and prior to Dilation and Evacuation: A Randomized Controlled Trial.

Contraception. 2020 Jan 09;:

Authors: Creinin MD, Schimmoeller NR, Matulich MC, Hou MY, Melo J, Chen MJ

Abstract
OBJECTIVE: To evaluate if gabapentin 600 mg reduces pain after osmotic dilator placement the day before a dilation and evacuation (D&E) procedure.
STUDY DESIGN: We conducted a double-blind, placebo-controlled, randomized (stratified by vaginal parity) trial among women undergoing osmotic dilator placement before D&E at 15 to 23 5/7 weeks gestation. Subjects received gabapentin 600 mg or placebo 30 minutes before dilator placement, with re-dosing 8 hours later. We assessed pain after dilator placement using a numeric rating scale (NRS; scale 0-10) at 5 minutes, 2, 4, and 8 hours, and at presentation for D&E. The primary outcome was median NRS pain score change from baseline to 8 hours after dilator placement. Secondary outcomes included gabapentin-related side effects and analgesic use.
RESULTS: Of 121 randomized women, we excluded three subjects (allergic reaction [placebo], randomization error, no NRS data), leaving 60 gabapentin and 58 placebo subjects. Of 110 (93%) women who provided 8-hour data, median pain score changes from baseline did not differ between gabapentin and placebo groups overall (2 vs. 2.5, p=0.52), in vaginally nulliparous women (2 vs. 4, p=0.10) or in parous women (2 vs. 1.5, p=0.37). We found no statistically significant differences in median pain score change from baseline to any timepoint overall or when stratified by parity. Beginning at 2 hours after dilator placement, more gabapentin than placebo users experienced dizziness (29/53[55%] vs. 11/53[21%], p=0.001) and tiredness (34/54[63%] vs. 17/54[31%], p=0.002). The proportion of women using narcotics did not differ between gabapentin (35/60[58%]) or placebo (40/58[69%]) users (p=0.26).
CONCLUSIONS: Gabapentin does not reduce pain with overnight osmotic dilator placement prior to D&E and causes drug-related side effects.

PMID: 31927028 [PubMed - as supplied by publisher]

Quality of electronic records documenting adverse drug reactions within a hospital setting: identification of discrepancies and information completeness.

N Z Med J. 2019 01 18;132(1488):28-37

Authors: Braund R, Lawrence CK, Baum L, Kessler B, Vassart M, Coulter C

Abstract
AIM: Incomplete and incorrect documentation of adverse drug reactions (ADRs) can restrict prescribing choices resulting in suboptimal pharmaceutical care. This study aimed to examine the quality of information held within electronic systems in a hospital setting, to determine the preciseness of ADR documentation, and identify discrepancies where multiple electronic systems are utilised.
METHOD: Over a four-week period, consecutive patients admitted to the general medical ward at the study hospital had their electronic profiles reviewed. Patient demographic information (de-identified), ADR history and discrepancies between information sources (as recorded in all electronic systems utilised at initial prescribing) were recorded and analysed.
RESULTS: Over the four-week period, 332 patient profiles were reviewed, and over 1,200 alerts were identified and analysed (including duplicates of ADR reactions). Of these patients, 151 (45.5%) had at least one documented allergy or intolerance which generated 585 reactions, relating to 526 unique events. A further 151 (45.5%) were classified as having no known (drug) allergies or intolerances; however, 20 (15%) of these patients did have at least one allergy documented in at least one other electronic system. The remaining 30 (9%) patients were classified as having an unknown allergy status and of those nine had allergies documented in at least one other electronic system. Further, most systems contained information duplication, which had not been addressed during the admission process.
CONCLUSION: ADR information was both imprecise and inaccurate, as multiple discrepancies between ADR information recorded in different electronic patient management systems were found to exist. Information sharing between systems needs to be prioritised in order to allow full, accurate and complete ADR information to be collected, stored and utilised; both to reduce current inadequacies and to allow optimal pharmaceutical care.

PMID: 31851659 [PubMed - indexed for MEDLINE]

Purging with chlorambucil to prevent infusion-related reaction before obinutuzumab administration: A monocentric pilot experience.

Hematol Oncol. 2019 Dec;37(5):641-643

Authors: Autore F, Fresa A, Innocenti I, Tomasso A, Morelli F, Corbingi A, Sorà F, Laurenti L

PMID: 31604368 [PubMed - indexed for MEDLINE]

Persistent adverse effects of antidepressants.

Epidemiol Psychiatr Sci. 2019 Sep 23;29:e56

Authors: Moncrieff J

PMID: 31543093 [PubMed - indexed for MEDLINE]

Use of renal risk drugs in a nation-wide Polish older adult population: an analysis of PolSenior database.

BMC Geriatr. 2019 03 05;19(1):70

Authors: Deskur-Śmielecka E, Chudek J, Neumann-Podczaska A, Mossakowska M, Wizner B, Wieczorowska-Tobis K

Abstract
BACKGROUND: Numerous medications should be avoided, or require dose adjustment in subjects with impaired kidney function. We aimed to assess the prevalence of potentially inappropriate use of renal risk drugs in a nation-wide, community-dwelling Polish older adult population.
METHODS: We analysed regular intake of 38 medications that should be avoided, requiring dose modification, increase the risk of pre-renal kidney injury, or may cause potassium retention in subjects with moderately to severely impaired renal function in the PolSenior data base (N = 4514, mean age 76 ± 11 yrs). Kidney function was assessed with short Modification of Diet in Renal Disease formula estimated glomerular filtration rate (sMDRD) and Cockcroft-Gault creatinine clearance (CC).
RESULTS: There were 855 (19%) individuals with sMDRD < 60 ml/min/1.73m2, and 1734 (38%) with CC <  60 ml/min. Among drugs that should be avoided, spironolactone (20.4% of patients as classified by sMDRD and 17.5% by CC), non-steroidal anti-inflammatory drugs (13.4 and 11.3%), hydrochlorothiazide (11.1 and 11.0%), and metformin (6.9 and 8.2%) were most frequently used. The most frequently used drugs requiring dose modification were piracetam (13.9% by sMDRD, and 11.9% by CC), digoxin (8.3 and 8.8%), and gliclazide (6.8 and 5.9%). Classification of a drug use as 'appropriate' or 'inappropriate' was discordant depending on the method of kidney function assessment (sMDRD or CC) in up to 30%. Subgroups with sMDRD < 60 ml/min/1.73m2 and with CC <  60 ml/min were taking ≥2 drugs increasing the risk of pre-renal kidney injury more frequently than individuals with better kidney function (46.6 vs. 23.1 and 33.0% vs. 24.4%, respectively). There were 24.7% of individuals with sMDRD < 60 ml/min/1.73m2 and 18.0% with CC <  60 ml/min taking 2 or more drugs increasing serum potassium level. The proportion of subjects with hyperkalaemia increased with the number of such drugs.
CONCLUSIONS: Use of drugs that should be avoided or require dose adjustment due to renal impairment, and potentially inappropriate drug combinations is a common problem in older adults in Poland. Assessment of kidney function with sMDRD may result in overlooking of requirements for dose adjustment formulated based on creatinine clearance.
TRIAL REGISTRATION: Not applicable.

PMID: 30836952 [PubMed - indexed for MEDLINE]

When Should Iatrogenic Polypharmacy Be Considered a Disease?

AMA J Ethics. 2018 12 01;20(12):E1133-1138

Authors: Wieseler C

Abstract
This case of an elderly patient taking 17 medications, who presents with new neurological symptoms, raises multiple philosophy of medicine questions, including, What is a disease? And what would it mean to treat iatrogenic polypharmacy? Polypharmacy can obscure whether a patient like the one in this case has a neurological disease. I argue that, insofar as polypharmacy is likely to have caused, or at least contributed to, this patient's symptoms, her physician should treat it as a disease.

PMID: 30585575 [PubMed - indexed for MEDLINE]

First-in-human clinical trial to assess safety, tolerability and pharmacokinetics of P218, a novel candidate for malaria chemoprotection.

Br J Clin Pharmacol. 2020 Jan 11;:

Authors: Chughlay MF, Rossignol E, Donini C, El Gaaloul M, Lorch U, Coates S, Langdon G, Hammond T, Möhrle J, Chalon S

Abstract
AIMS: This first-in-human clinical trial of P218, a novel dihydrofolate reductase inhibitor antimalarial candidate, assessed safety, tolerability, pharmacokinetics and food effect in healthy subjects.
METHODS: The study consisted of two parts. Part A was a double-blind, randomised, placebo-controlled, parallel group, ascending dose study comprised of seven fasted cohorts. Eight subjects/cohort were randomised (3:1) to receive either a single oral dose of P218 (10, 30, 100, 250, 500, 750 and 1000 mg) or placebo. Part B was an open-label, cross-over, fed/fasted cohort (eight subjects) that received a 250 mg single dose of P218 in two treatment periods.
RESULTS: P218 was generally well tolerated across all doses; 21 treatment-emergent adverse events occurred in 15/64 subjects. Nine adverse events in five subjects, all of mild intensity, were judged drug related. No clinically relevant abnormalities in ECG, vital signs or laboratory tests changes were observed. P218 was rapidly absorbed with Cmax achieved between 0.5-2 h post-dose. Plasma concentrations declined bi-exponentially with half-life values ranging from 3.1-6.7 h (10 and 30 mg), increasing up to 8.9-19.6 h (doses up to 1000 mg). Exposure values increased dose-proportionally between 100 and 1000 mg for P218 (parent) and three primary metabolites (P218 β-acyl glucuronide, P218-OH and P218-OH β-acyl glucuronide). Co-administration of P218 with food reduced Cmax by 35% and delayed absorption by 1 h, but with no significant impact on AUC.
CONCLUSION: P218 displayed favourable safety, tolerability and pharmacokinetics. In view of its short half-life, a long-acting formulation will be needed for malaria chemoprotection.

PMID: 31925817 [PubMed - as supplied by publisher]

Occurrence of abscesses during treatment with pazopanib in metastatic renal cancer: a case report.

J Med Case Rep. 2020 Jan 11;14(1):7

Authors: Puliafito I, Russo A, Sciacca D, Puglisi C, Giuffrida D

Abstract
BACKGROUND: Pazopanib is a multitarget tyrosine kinase inhibitor used in the treatment of renal cancer and soft tissue sarcoma. Its use is commonly associated with a number of side effects, such as hemorrhagic diathesis, neutropenia, leukopenia, thrombocytopenia, nausea, vomiting, abdominal pain, increased serum aspartate aminotransferase, increased serum alanine aminotransferase, decreased serum glucose, increased serum bilirubin, decreased serum phosphate and magnesium, fatigue, hypertension, diarrhea, anorexia, proteinuria, and hypothyroidism. Abscesses of metastases caused by pazopanib administration are rarely reported in the literature.
CASE PRESENTATION: We report a case of abscesses of lung metastases related to pazopanib in a patient with metastatic renal cancer. The patient was a 53-year-old Caucasian man who developed abscesses of lung metastases during the first 3 months of treatment with pazopanib. The abscesses resolved after 1 month by stopping pazopanib and administering adequate antibiotic therapy.
CONCLUSIONS: We conclude that abscesses of metastases could be a rare side effect occurring during treatment with pazopanib in patients with renal cancer.

PMID: 31924259 [PubMed - in process]

Clinical outcomes of teicoplanin use in the OPAT setting.

Int J Antimicrob Agents. 2020 Jan 07;:105888

Authors: Dabrowski H, Wickham H, De S, Underwood J, Morris-Jones S, Logan S, Marks M, Pollara G

Abstract
Teicoplanin possesses several convenient properties for use in the delivery of outpatient parenteral antimicrobial therapy (OPAT) services. However, its use is not widespread and data on its efficacy in the OPAT setting are limited. We present a case series of patients undergoing OPAT care being treated by either teicoplanin-based (n = 107) or ceftriaxone-based (n = 191) antibiotic regimens. Clinical failure with teicoplanin occurred in 5 episodes of care (4.7%), whereas clinical failure occurred in 2 episodes of ceftriaxone-based OPAT care (1.0%). Teicoplanin-associated clinical failure was observed in 2 of 6 (33%) patients with Enterococcus infections, compared to 3 of 101 (3.1%) of patient with non-Enterococcus infections. Overall there were 4 (2.9%) drug-related adverse events for teicoplanin and 4 (1.8%) for ceftriaxone, prompting a switch to teicoplanin in 3 patients. Our findings support the continued use of teicoplanin in OPAT and its consideration in centres where it is not currently being offered.

PMID: 31923571 [PubMed - as supplied by publisher]

Effective Use of the Laboratory in the Management of Patients with Inflammatory Bowel Diseases.

Gastroenterol Clin North Am. 2019 06;48(2):237-258

Authors: Ince MN, Elliott DE

Abstract
Inflammatory bowel disease (IBD) comprises a group of chronic, intestinal inflammatory disorders, including ulcerative colitis and Crohn's disease. IBD is characterized by periods of relapse and remission. Long-term progressive intestinal inflammation can result in severe and devastating complications, such as intestinal strictures and/or fistulae. Immune suppressive medications with potent side effects are often used to control inflammation and limit disease activity. Laboratory tests guide various decisions in clinical management of IBD. We discuss tests used to diagnose IBD, assess for relapse or remission, monitor the effectiveness of therapeutic regimen, screen for the maintenance of health, and diagnose or prevent complications.

PMID: 31046973 [PubMed - indexed for MEDLINE]

Implantable Pumps Require Specific Medications To Prevent Pump Failure And Risks To Patient Safety.

Am J Nurs. 2019 04;119(4):20-21

Authors: Aschenbrenner DS

PMID: 30896485 [PubMed - indexed for MEDLINE]

New Warning for Fluoroquinolone Antibiotics.

Am J Nurs. 2019 04;119(4):20

Authors: Aschenbrenner DS

PMID: 30896484 [PubMed - indexed for MEDLINE]

12 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

("drug-induced" OR "drug-related") AND ("adverse events" OR "side effects" OR "side-effects")

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PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

12 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

("drug-induced" OR "drug-related") AND ("adverse events" OR "side effects" OR "side-effects")

These pubmed results were generated on 2020/01/10

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

Immunotherapy-Induced Airway Disease: A New Pattern of Lung Toxicity of Immune Checkpoint Inhibitors.

Respiration. 2020 Jan 08;:1-6

Authors: Mitropoulou G, Daccord C, Sauty A, Pasche A, Egger B, Aedo Lopez V, Letovanec I, Beigelman-Aubry C, Nicod LP, Lazor R

Abstract
Immune checkpoint inhibitors (ICIs) have been shown to improve overall and progression-free survival in various cancers but have been associated with various immune-related adverse events (IRAEs), including interstitial lung disease, especially organizing pneumonia. We report 2 cases of isolated severe airway disease attributable to ICIs, a rarely reported pattern of lung toxicity. The first patient received nivolumab with or without ipilimumab in a randomized double-blind trial for locoregional metastatic melanoma. The second patient was treated with nivolumab for lung adenocarcinoma. An IRAE was suspected in both cases due to a temporal relationship between ICI initiation and symptom onset. ICIs were stopped, and high-dose prednisone, inhaled corticosteroids, and bronchodilators were administered, allowing a rapid clinical and functional improvement in Patient 1. In Patient 2, despite prolonged high-dose prednisone, only a stabilization of forced expiratory volume in 1 s could be achieved, and the disease course was complicated by respiratory infections resulting in further loss of lung function. The patient died 1 year later due to progression of metastatic disease. These 2 cases suggest that pulmonary IRAEs secondary to ICIs may present as isolated bronchitis or bronchiolitis, with variable outcomes following ICI withdrawal and systemic corticosteroids.

PMID: 31914436 [PubMed - as supplied by publisher]