Version 1
: Received: 22 August 2024 / Approved: 23 August 2024 / Online: 23 August 2024 (12:21:14 CEST)
How to cite:
Gupta, M.; Graham, C. D.; Gupta, S. Immune Checkpoint Inhibitor Associated Celiac Disease: A Retrospective Analysis and Literature Review. Preprints2024, 2024081683. https://doi.org/10.20944/preprints202408.1683.v1
Gupta, M.; Graham, C. D.; Gupta, S. Immune Checkpoint Inhibitor Associated Celiac Disease: A Retrospective Analysis and Literature Review. Preprints 2024, 2024081683. https://doi.org/10.20944/preprints202408.1683.v1
Gupta, M.; Graham, C. D.; Gupta, S. Immune Checkpoint Inhibitor Associated Celiac Disease: A Retrospective Analysis and Literature Review. Preprints2024, 2024081683. https://doi.org/10.20944/preprints202408.1683.v1
APA Style
Gupta, M., Graham, C. D., & Gupta, S. (2024). Immune Checkpoint Inhibitor Associated Celiac Disease: A Retrospective Analysis and Literature Review. Preprints. https://doi.org/10.20944/preprints202408.1683.v1
Chicago/Turabian Style
Gupta, M., Christopher David Graham and Supriya Gupta. 2024 "Immune Checkpoint Inhibitor Associated Celiac Disease: A Retrospective Analysis and Literature Review" Preprints. https://doi.org/10.20944/preprints202408.1683.v1
Abstract
Introduction: Immune checkpoint inhibitors (ICI) are used to treat various malignancies. They block the inhibitory signals of tumor cells and enhance the inflammatory cascade which results in tumor killing. However, this can lead to unchecked inflammation throughout the body, leading to various adverse effects. A rare gastrointestinal adverse effect of ICI therapy is the development of immune-mediated celiac disease. This entity has a similar clinical presentation to the more common ICI-induced enterocolitis. Our study aims to determine the clinical characteristics and optimal treatment strategies for this rare ICI toxicity, and differentiate it from ICI-induced enterocolitis. Methods and Material: We conducted a retrospective analysis of eight cases of ICI-induced celiac disease and 24 cases of ICI-induced enterocolitis from the literature. Data on patient demographics, clinical history, therapeutic interventions and outcomes were collected. Comparative analysis was performed to identify the key differences between the two groups. Results: Patients with ICI-induced celiac disease were more likely to have a pre-existing autoimmune condition and HLA-DQ2 positivity. Significant differences in clinical manifestations, histological findings, and treatment outcomes were observed. Notably, weight loss, nutritional deficiencies and electrolyte abnormalities were more commonly associated with ICI-CD. On pathology, duodenal villous blunting was noted more commonly with ICI-induced celiac disease. Initiating a gluten-free diet led to rapid improvement in patients with ICI-induced celiac disease, while immunosuppressive therapy did not have an impact. Conclusion: ICI-induced celiac disease is a rare and underrecognized gastrointestinal adverse effect of ICI therapy, often misdiagnosed as ICI-induced enterocolitis. Early recognition and treatment with a gluten-free diet can lead to rapid symptom resolution, sparing patients from unnecessary systemic immunosuppression and discontinuation of antineoplastic immunotherapy.
Medicine and Pharmacology, Oncology and Oncogenics
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
