Cutaneous immune-related adverse events often precede noncutaneous events

Cutaneous immune-related adverse events are an early sign of immune-mediated toxic events, and dermatologists can play a role in screening for more severe events, according to a study.

“Cutaneous immune-related adverse events (cirAEs) are some of the earliest toxic effects to emerge following initiation of immune checkpoint inhibitor (ICI) therapy,” Leah L. Thompson, BA, of the department of dermatology, Massachusetts General Hospital, Harvard Medical School, and colleagues wrote.

The retrospective cohort study screened 2,459 patients who began anti-programmed death 1/ligand 1 and/or anticytotoxic-T-lymphocyte-4 ICI therapy.

Cutaneous immune-related adverse events developed in 358 patients (14.5%). The most popular events included maculopapular or papulopustular reactions (52%), pruritis without visible cutaneous manifestations (18.4%) and eczematous reactions (7%).

Noncutaneous immune-related adverse events (irAEs) developed in 177 patients (49.4%) who had cutaneous events. Of these, 128 (72.3%) developed a cutaneous event before the noncutaneous event and 67 (18.7%) developed multiple irAEs.

Gastroenterocolitis (57 events, 20.8%), thyroiditis (53 events, 19.3%) and hepatoxicity (39 events, 14.2%) were the most common irAEs.

“The irAE diagnoses associated with cirAEs are some of the most significant ICI-associated toxic effects,” the authors wrote.

The study’s limitations included a small number of patients within certain adverse event subgroups and a low number of cutaneous events overall.

“Despite the constraints of this study, our findings provide further characterization of associations between specific subgroups of cirAEs and irAEs, providing information that may be valuable in the care of high-risk patients with multiple ICI-associated toxic effects,” the authors wrote. “Dermatologists may play a crucial role in the care of patients with cirAEs with targeted screening for potential noncutaneous irAEs.”