Pneumotox » Drug » Ipilimumab

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)

Last update : 05/05/2018

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

I.b Pneumonitis (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.b ARDS - Acute lung injury

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

V.m Pleuropericarditis - Pleuropericardial effusion (ANA unknown or negative)

VII.e Granulomatous mediastinal lymphadenopathy

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.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.c Pericardial effusion (w/wo tamponade)

XII.d Myocarditis (can be fulminant)

XII.az Fulminant myocarditis (See also under XIId)

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

XV.ci Path: Fibrinous pericarditis

XVI.bh Imaging: F18-PET scan positive lympadenopathy

XVII.b Opportunistic pulmonary/systemic infections

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

XIX.a BAL: An excess proportion of lymphocytes

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France