PMID- 36449057 OWN - NLM STAT- MEDLINE DCOM- 20230228 LR - 20230228 IS - 1437-160X (Electronic) IS - 0172-8172 (Linking) VI - 43 IP - 3 DP - 2023 Mar TI - Anti-programmed death-1 inhibitor nivolumab-induced immune-related adverse events: hepatitis, renal insufficiency, myositis, vitiligo, and hypothyroidism: a case-based review. PG - 559-565 LID - 10.1007/s00296-022-05247-5 [doi] AB - Nivolumab (NIVO) is a monoclonal antibody used to treat renal cell cancer. It is an anti-programmed death-1 (anti-PD-1) inhibitor, enhancing the tumor-targeted immune response of T lymphocytes, resulting in immune-mediated adverse events (AEs). We present five immunological AEs in a single patient treated with NIVO. A 68-year-old male patient with metastatic renal cell carcinoma and right-sided nephrectomy received NIVO after pazopanib and sunitinib treatment. Two and a half months after starting NIVO, hepatocellular enzymes and creatinine were elevated. Concomitantly, the patient noticed hypopigmentation of the hand skin and a change in voice and speech. Due to hepatitis, he has been treated with dexamethasone 16 mg daily for 22 days, after which hypothyroidism and increased creatine kinase were found without muscle pain and functional impairment. Dexamethasone was continued, and a rapid decline in all parameters except thyroid-stimulating hormone (TSH) and vitiligo was observed. Myositis was initially considered a part of hypothyroidism and elevated renal parameters due to hypohydration. The rapid regression on glucocorticoid treatment and a longer time for creatinine normalization than expected with hydration were noticed. Nivolumab likely induced those side effects as assessed by Naranjo Adverse Drug Reaction Probability Scale. The literature review shows that the consequences of PD-1 inhibition are not uniform. Side effects of checkpoint inhibitors should be monitored carefully in the early and later treatment schedules evaluating subclinical manifestations like myositis and worsening of kidney parameters. Early administered higher doses of glucocorticoids can stop drug toxicity and reverse-induced tissue damage. CI - (c) 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Zekic, Tatjana AU - Zekic T AUID- ORCID: 0000-0001-7948-5394 AD - Faculty of Medicine, Clinical Hospital Center Rijeka, Department of Rheumatology and Clinical Immunology, University of Rijeka, Rijeka, Croatia. tatjana.zekic@ri.t-com.hr. FAU - Benic, Mirjana Stanic AU - Benic MS AUID- ORCID: 0000-0002-4123-9937 AD - Department of Pharmacology, Clinical Hospital Center Rijeka, Rijeka, Croatia. LA - eng PT - Case Reports PT - Journal Article PT - Review DEP - 20221130 PL - Germany TA - Rheumatol Int JT - Rheumatology international JID - 8206885 RN - 31YO63LBSN (Nivolumab) RN - AYI8EX34EU (Creatinine) RN - 7S5I7G3JQL (Dexamethasone) SB - IM MH - Male MH - Humans MH - Aged MH - Nivolumab/adverse effects MH - *Carcinoma, Renal Cell/chemically induced/drug therapy/pathology MH - *Vitiligo/chemically induced/drug therapy MH - Creatinine MH - *Kidney Neoplasms/chemically induced/drug therapy/pathology MH - *Hypothyroidism MH - *Myositis/drug therapy MH - *Drug-Related Side Effects and Adverse Reactions MH - *Hepatitis MH - *Renal Insufficiency MH - Dexamethasone/adverse effects OTO - NOTNLM OT - Chronic OT - Hepatitis OT - Myositis OT - PD-L1 Inhibitors OT - Renal Insufficiency OT - Thyroid gland OT - Toxic OT - Vitiligo EDAT- 2022/12/01 06:00 MHDA- 2023/03/03 06:00 CRDT- 2022/11/30 11:14 PHST- 2022/09/19 00:00 [received] PHST- 2022/11/09 00:00 [accepted] PHST- 2022/12/01 06:00 [pubmed] PHST- 2023/03/03 06:00 [medline] PHST- 2022/11/30 11:14 [entrez] AID - 10.1007/s00296-022-05247-5 [pii] AID - 10.1007/s00296-022-05247-5 [doi] PST - ppublish SO - Rheumatol Int. 2023 Mar;43(3):559-565. doi: 10.1007/s00296-022-05247-5. Epub 2022 Nov 30.