Immunotherapies
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Optic neuritis: 11 case reports In a retrospective study involving 11 patients, who were diagnosed with optic neuritis between 22 May 2017 and 15 January 2020 in the USA, 11 patients (6 women and 5 men) aged 54–73 years were described, who developed optic neuritis during treatment with ipilimumab, nivolumab, pembrolizumab or atezolizumab for cutaneous melanoma, small cell lung cancer, non-small cell lung cancer or renal cell carcinoma [routes and duration of treatments to reactions onsets not stated]. The patients’, who had cutaneous melanoma (5 patients), small cell lung cancer (2 patients), non-small cell lung cancer (3 patients) and renal cell carcinoma (1 patient), started receiving treatment with ipilimumab 3 mg/kg and nivolumab 1 mg/kg every 3 weeks (1 patient), ipilimumab 3 mg/kg and nivolumab 1 mg/kg every 3 weeks, followed by nivolumab (1 patient), nivolumab 240mg every 3 weeks (1 patient), pembrolizumab 200mg monthly and pemetrexed 200mg ( patient), ipilimumab 1 mg/kg every 6 weeks and nivolumab 240mg every 3 weeks (1 patient), ipilimumab 3 mg/kg and nivolumab 1 mg/kg every 3 weeks (1 patient), atezolizumab 1200 mg every 3 weeks (1 patient), pembrolizumab 2 mg/kg every 3 weeks (1 patient), ipilimumab 3 mg/kg and nivolumab 1 mg/kg every 3 weeks (1 patient), nivolumab 2 mg/kg every 2 weeks (1 patient), and ipilimumab 3 mg/kg and nivolumab 1 mg/kg every 3 weeks; nivolumab 1 mg/kg rechallenge once (1 patient). The patients presented with decreased vision, floaters, smudge, halos, peripheral vision loss or redness following 2–95 cycles of immune checkpoint inhibitor therapy. The patients were diagnosed with bilateral optic neuritis (7 patients) and unilateral optic neuritis (4 patients) secondary to the use of immune checkpoint inhibitor therapy. The patients’ immune checkpoint inhibitors treatment was discontinued. Subsequently, the patients’ received treatment with prednisone, timolol, dorzolamide, dexamethasone, rituximab, plasma exchange, methylprednisone, difluprednate or brimonidine. After treatment, optic nerve examination revealed trace nasal pallor in both eyes (1 patient), trace diffuse pallor in both eyes (1 patient), pallor of superior left disc (1 patient), disc pallor with resolved edema, thinning in both eyes (1 patient), normal (2 patients), superonasal disc pallor, corresponding nerve fiber layer optical coherence tomography thinning (1 patient), optic nerve pallor in right eye (1 patient), slightly less edema, resolved flame haemorrhages (1 patient), optic nerve pallor in both eyes (1 patient), and pink in right eye, 4+ pallor in left eye (1 patient). Of these 11 patients, 3 patients died [cause of death not stated]. Francis JH, et al. Immune Checkpoint Inhibitor-Associated Optic Neuritis. Ophthalmology 127: 1585-1589, No. 11, Nov 2020. Available from: URL: http://doi.org/10.1016/ 803518629 j.ophtha.2020.05.003
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Reactions 5 Dec 2020 No. 1833
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