Immune-related adverse events requiring hospitalization: Spectrum of toxicity, treatment, and outcomes

Aanika Balaji, Jiajia Zhang, Beatriz Wills, Kristen Marrone, Hany Elmariah, Mark Yarchoan, Jacquelyn W. Zimmerman, Khalid Hajjir, Deepti Venkatraman, Deborah Kay Armstrong, Daniel Laheru, Ranee Mehra, Won Jin Ho, Joshua E. Reuss, Joseph Heng, Paz Vellanki, Ross C Donehower, Matthias Holdhoff, Jarushka Naidoo

Research output: Contribution to journalArticle

Abstract

PURPOSE Immune checkpoint inhibitors (ICIs) cause immune-related adverse events (irAEs). The proportion of patients who are hospitalized for irAEs and their spectrum, management, and outcomes are not well described. METHODS We report the proportion of hospitalized patients in an academic center who were treated with ICIs from May to December 2017. Patient characteristics, toxicities, management, and outcomes for confirmed irAE admissions are reported. Associations between patient features and irAE hospitalizations are examined. RESULTS Twenty-three percent (n = 100) of 443 patients who were admitted to an academic oncology center over 6 months had ever received ICIs. Of these patients, 41% were admitted for suspected irAEs and 23% were confirmed irAEs. IrAEs accounted for 5% of all oncology hospitalizations (n = 23). Ninety-one percent of patients with confirmed irAEs prompted a medicine subspecialist consultation, most commonly gastroenterology (22%). Fifteen patients (65%) had their irAEs improve/resolve, seven (30%) had worsening irAEs, and three (13%) died of their irAEs. The majority of patients (n = 20; 87%) discontinued ICIs after discharge. Among ICI-treated patients who required admission, an increased likelihood of irAE-related hospitalization was associated with patient age older than 65 years (odds ratio, 5.4; 95% CI, 1.6 to 17.8) and receipt of combination immunotherapy (OR, 6.8; 95% CI, 2.0 to 23.2). CONCLUSION A notable proportion of ICI-treated patients are hospitalized for irAEs, and these patients have a high demand for multidisciplinary management. Older age and combination ICI treatment were associated with an increased risk of irAE-related hospitalization. Whereas these data are from an academic center and include patients in clinical trials, with expanding use of ICIs, these data have important implications for inpatient service planning and risk stratification.

Original languageEnglish (US)
Pages (from-to)E825-E834
JournalJournal of oncology practice
Volume15
Issue number9
DOIs
StatePublished - Jan 1 2019

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Hospitalization
Gastroenterology
Immunotherapy
Inpatients
Referral and Consultation
Odds Ratio
Medicine
Clinical Trials

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

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Immune-related adverse events requiring hospitalization : Spectrum of toxicity, treatment, and outcomes. / Balaji, Aanika; Zhang, Jiajia; Wills, Beatriz; Marrone, Kristen; Elmariah, Hany; Yarchoan, Mark; Zimmerman, Jacquelyn W.; Hajjir, Khalid; Venkatraman, Deepti; Armstrong, Deborah Kay; Laheru, Daniel; Mehra, Ranee; Ho, Won Jin; Reuss, Joshua E.; Heng, Joseph; Vellanki, Paz; Donehower, Ross C; Holdhoff, Matthias; Naidoo, Jarushka.

In: Journal of oncology practice, Vol. 15, No. 9, 01.01.2019, p. E825-E834.

Research output: Contribution to journalArticle

Balaji, A, Zhang, J, Wills, B, Marrone, K, Elmariah, H, Yarchoan, M, Zimmerman, JW, Hajjir, K, Venkatraman, D, Armstrong, DK, Laheru, D, Mehra, R, Ho, WJ, Reuss, JE, Heng, J, Vellanki, P, Donehower, RC, Holdhoff, M & Naidoo, J 2019, 'Immune-related adverse events requiring hospitalization: Spectrum of toxicity, treatment, and outcomes', Journal of oncology practice, vol. 15, no. 9, pp. E825-E834. https://doi.org/10.1200/JOP.18.00703
Balaji, Aanika ; Zhang, Jiajia ; Wills, Beatriz ; Marrone, Kristen ; Elmariah, Hany ; Yarchoan, Mark ; Zimmerman, Jacquelyn W. ; Hajjir, Khalid ; Venkatraman, Deepti ; Armstrong, Deborah Kay ; Laheru, Daniel ; Mehra, Ranee ; Ho, Won Jin ; Reuss, Joshua E. ; Heng, Joseph ; Vellanki, Paz ; Donehower, Ross C ; Holdhoff, Matthias ; Naidoo, Jarushka. / Immune-related adverse events requiring hospitalization : Spectrum of toxicity, treatment, and outcomes. In: Journal of oncology practice. 2019 ; Vol. 15, No. 9. pp. E825-E834.
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abstract = "PURPOSE Immune checkpoint inhibitors (ICIs) cause immune-related adverse events (irAEs). The proportion of patients who are hospitalized for irAEs and their spectrum, management, and outcomes are not well described. METHODS We report the proportion of hospitalized patients in an academic center who were treated with ICIs from May to December 2017. Patient characteristics, toxicities, management, and outcomes for confirmed irAE admissions are reported. Associations between patient features and irAE hospitalizations are examined. RESULTS Twenty-three percent (n = 100) of 443 patients who were admitted to an academic oncology center over 6 months had ever received ICIs. Of these patients, 41{\%} were admitted for suspected irAEs and 23{\%} were confirmed irAEs. IrAEs accounted for 5{\%} of all oncology hospitalizations (n = 23). Ninety-one percent of patients with confirmed irAEs prompted a medicine subspecialist consultation, most commonly gastroenterology (22{\%}). Fifteen patients (65{\%}) had their irAEs improve/resolve, seven (30{\%}) had worsening irAEs, and three (13{\%}) died of their irAEs. The majority of patients (n = 20; 87{\%}) discontinued ICIs after discharge. Among ICI-treated patients who required admission, an increased likelihood of irAE-related hospitalization was associated with patient age older than 65 years (odds ratio, 5.4; 95{\%} CI, 1.6 to 17.8) and receipt of combination immunotherapy (OR, 6.8; 95{\%} CI, 2.0 to 23.2). CONCLUSION A notable proportion of ICI-treated patients are hospitalized for irAEs, and these patients have a high demand for multidisciplinary management. Older age and combination ICI treatment were associated with an increased risk of irAE-related hospitalization. Whereas these data are from an academic center and include patients in clinical trials, with expanding use of ICIs, these data have important implications for inpatient service planning and risk stratification.",
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T1 - Immune-related adverse events requiring hospitalization

T2 - Spectrum of toxicity, treatment, and outcomes

AU - Balaji, Aanika

AU - Zhang, Jiajia

AU - Wills, Beatriz

AU - Marrone, Kristen

AU - Elmariah, Hany

AU - Yarchoan, Mark

AU - Zimmerman, Jacquelyn W.

AU - Hajjir, Khalid

AU - Venkatraman, Deepti

AU - Armstrong, Deborah Kay

AU - Laheru, Daniel

AU - Mehra, Ranee

AU - Ho, Won Jin

AU - Reuss, Joshua E.

AU - Heng, Joseph

AU - Vellanki, Paz

AU - Donehower, Ross C

AU - Holdhoff, Matthias

AU - Naidoo, Jarushka

PY - 2019/1/1

Y1 - 2019/1/1

N2 - PURPOSE Immune checkpoint inhibitors (ICIs) cause immune-related adverse events (irAEs). The proportion of patients who are hospitalized for irAEs and their spectrum, management, and outcomes are not well described. METHODS We report the proportion of hospitalized patients in an academic center who were treated with ICIs from May to December 2017. Patient characteristics, toxicities, management, and outcomes for confirmed irAE admissions are reported. Associations between patient features and irAE hospitalizations are examined. RESULTS Twenty-three percent (n = 100) of 443 patients who were admitted to an academic oncology center over 6 months had ever received ICIs. Of these patients, 41% were admitted for suspected irAEs and 23% were confirmed irAEs. IrAEs accounted for 5% of all oncology hospitalizations (n = 23). Ninety-one percent of patients with confirmed irAEs prompted a medicine subspecialist consultation, most commonly gastroenterology (22%). Fifteen patients (65%) had their irAEs improve/resolve, seven (30%) had worsening irAEs, and three (13%) died of their irAEs. The majority of patients (n = 20; 87%) discontinued ICIs after discharge. Among ICI-treated patients who required admission, an increased likelihood of irAE-related hospitalization was associated with patient age older than 65 years (odds ratio, 5.4; 95% CI, 1.6 to 17.8) and receipt of combination immunotherapy (OR, 6.8; 95% CI, 2.0 to 23.2). CONCLUSION A notable proportion of ICI-treated patients are hospitalized for irAEs, and these patients have a high demand for multidisciplinary management. Older age and combination ICI treatment were associated with an increased risk of irAE-related hospitalization. Whereas these data are from an academic center and include patients in clinical trials, with expanding use of ICIs, these data have important implications for inpatient service planning and risk stratification.

AB - PURPOSE Immune checkpoint inhibitors (ICIs) cause immune-related adverse events (irAEs). The proportion of patients who are hospitalized for irAEs and their spectrum, management, and outcomes are not well described. METHODS We report the proportion of hospitalized patients in an academic center who were treated with ICIs from May to December 2017. Patient characteristics, toxicities, management, and outcomes for confirmed irAE admissions are reported. Associations between patient features and irAE hospitalizations are examined. RESULTS Twenty-three percent (n = 100) of 443 patients who were admitted to an academic oncology center over 6 months had ever received ICIs. Of these patients, 41% were admitted for suspected irAEs and 23% were confirmed irAEs. IrAEs accounted for 5% of all oncology hospitalizations (n = 23). Ninety-one percent of patients with confirmed irAEs prompted a medicine subspecialist consultation, most commonly gastroenterology (22%). Fifteen patients (65%) had their irAEs improve/resolve, seven (30%) had worsening irAEs, and three (13%) died of their irAEs. The majority of patients (n = 20; 87%) discontinued ICIs after discharge. Among ICI-treated patients who required admission, an increased likelihood of irAE-related hospitalization was associated with patient age older than 65 years (odds ratio, 5.4; 95% CI, 1.6 to 17.8) and receipt of combination immunotherapy (OR, 6.8; 95% CI, 2.0 to 23.2). CONCLUSION A notable proportion of ICI-treated patients are hospitalized for irAEs, and these patients have a high demand for multidisciplinary management. Older age and combination ICI treatment were associated with an increased risk of irAE-related hospitalization. Whereas these data are from an academic center and include patients in clinical trials, with expanding use of ICIs, these data have important implications for inpatient service planning and risk stratification.

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