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The Drug-Induced Respiratory Disease Website and App

Ipilimumab

An inhibitor of CTL A-4 lymphocyte domain used to treat melanoma (PMID 23714523). Reviews on management of AE at PMID 23772560, 24278787. Incidence of ILD higher if ipilumab and nivolumab are given concomitantly (PMID 25891304)

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.a

Pneumonitis (ILD), acute and/or severe (may produce the ARDS pattern)
I.b

Pneumonitis (interstitial lung disease/ILD)
I.d

Organizing pneumonia pattern (an area or areas of consolidation on imaging)
I.m

ILD with a granulomatous component
I.v

Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence

II - Pulmonary edema - Acute lung injury - ARDS

II.b

ARDS - Acute lung injury

IV - Airway involvement

IV.ab

Exacerbation or deterioration of preexisting COPD

V - Pleural and/or pericardial involvement

V.a

Pleural effusion (uni- or bilateral) (can accompany DI-LDs)
V.m

Pleuropericarditis - Pleuropericardial effusion (ANA unknown or negative)

VII - Mediastinal involvement

VII.e

Granulomatous mediastinal lymphadenopathy

IX - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

IX.j

Phrenic nerve injury - Hemi- or bilateral diaphragmatic paralysis
IX.r

Myasthenia gravis - Myasthenic-like syndrome
IX.ab

Guillain-Barré (or GB-like) syndrome (w/wo ARF)

X - Systemic/Distant conditions, syndromes and reactions

X.a

DRES syndrome - DRESS-like reaction
X.e

Autoimmunity-Autoimmune conditions (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)
X.g

Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)
X.j

Myopathy-Myositis-Polymyositis (see also under Xba)
X.k

Sarcoid-like granulomatosis (endo-/extrathoracic)
X.l

Systemic granulomatosis other than Xk
X.o

Neutrophilic dermatosis (Pyoderma, Sweet syndrome)
X.am

Immune-related adverse effect/toxicity

XII - Cardiovascular involvement / toxicity

XII.c

Pericardial effusion (w/wo tamponade)
XII.d

Myocarditis (can be fulminant)
XII.az

Fulminant myocarditis (See also under XIId)
XII.bz

Fulminate myocarditis

XV - Pathology

XV.c

Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)
XV.ci

Path: Fibrinous pericarditis

XVI - Imaging

XVI.bh

Imaging: F18-PET scan positive lympadenopathy

XVII - Infections & related conditions

XVII.b

Opportunistic pulmonary/systemic infections
XVII.c

Aspergillosis, pulmonary (invasive, allergic [ABPA], or mycetoma)

XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA

XIX.a

BAL: An excess proportion of lymphocytes