Abstract
Purpose :
Immune-related ocular toxicities, although rare, represent serious adverse events that could potentially arise from the use of immune checkpoint inhibitors (ICIs). Additionally, little is known about the association of ophthalmic immune-related adverse events (irAEs) and overall survival. In this retrospective cohort study, we utilized a real-world database to evaluate the rate of ophthalmic irAEs after receiving ICIs and its association with survival.
Methods :
Data were retrospectively obtained from TriNetX, an aggregated electronic health records database. Billing codes were used to identify adults receiving ICIs for commonly indicated cancers. Patients who developed ophthalmic irAEs within 1 year after the first instance of ICI therapy were included. ICI treatment groups included PD-1 inhibitors, PD-L1 inhibitors, CTLA-4 inhibitors, or combination therapy (ipilimumab + nivolumab). Participants with ocular toxicities 6 months before ICI treatment were excluded. A 6-month and 12-month landmark analysis using a Cox proportional hazard model was performed to evaluate the association of ophthalmic irAEs with overall survival. Subjects were propensity score matched to controls to adjust for demographics and cancer type.
Results :
A cohort of 36,064 patients taking any ICI was included, comprising 57.7% males with a mean age of 64.3±12.9 years. The five most prevalent ophthalmic irAEs in this cohort were dry eye syndrome (1.94%), conjunctivitis (0.76%), blepharitis (0.48%), anterior uveitis (0.38%), and keratitis (0.36%). Dry eye syndrome was the most common irAE among all ICI classes. Subjects taking combination therapy (n = 3,284) or CTLA-4 inhibitors (n = 768) had higher rates of anterior uveitis (1.28% and 1.17%, respectively) than PD-1 inhibitors (0.27%) and PD-L1 inhibitors (0.14%). Although not statistically significant, irAEs of the cornea and ocular surface (HR: 0.986), orbital and ocular adnexa (HR: 0.636), and uveitis (HR: 0.617) were associated with protection against mortality while neuro-ophthalmic irAEs were not (HR: 1.461).
Conclusions :
In all ICI classes, irAEs mostly involved the cornea and ocular surface. CTLA-4 inhibitors and combination therapy had higher rates of anterior uveitis. Ophthalmic irAEs are rare but could be more common than previously estimated. This insight could aid clinicians in better managing care for patients on ICIs.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.