Increased Reporting of Immune Checkpoint Inhibitor-Associated Diabetes.

Abstract

Immune checkpoint inhibitors (CPI) have proven remarkably effective in treating many types of malignancies but have been associated with significant risk for immune-related adverse events (irAEs) (1). Among these, new onset of insulin-dependent diabetes mellitus (DM) occurs in 0.2–1.0% of patients (2,3) and is being seen more frequently as CPI become more widely used. However, the incidence, clinical course, and pathogenesis of CPI-associated DM (CPI-DM) are not well understood. To better understand the characteristics of CPI-DM, we analyzed VigiBase (4), the World Health Organization’s database of individual case safety reports, and detected 283 cases of new-onset DM from 2014 to April 2018 following treatment with CPI using the following preferred terms according to MedDRA (Medical Dictionary for Regulatory Activities): diabetic ketoacidosis (DKA), diabetic ketosis, type 1 diabetes mellitus, or fulminant type 1 diabetes mellitus; any one of these was sufficient to define CPI-DM. We noted a marked increase in reporting of CPI-DM over this time period, with over 50% of cases reported in 2017 (Table 1). Overall, half of the patients with DM presented in DKA (50.2%); 5.6% of all cases were also on steroids at diagnosis of DM, and 6.4% were on noninsulin diabetes medications in addition to insulin. …