Abstract 988P
Background
Immune checkpoint inhibitors (ICIs)-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) has been reported. As ocular complications are the major long-term debilitating sequela following SJS/TEN, in this study, ocular manifestations of ICI-induced SJS/TEN are for the first time investigated.
Methods
In this multi-center prospective cohort study, patients with ICI-associated SJS/TEN underwent ophthalmic examination. The severity of acute ocular surface involvement was documented by the Ocular Surface Grading Score (OSGS), with which components including conjunctival hyperemia, pseudomembrane formation, conjunctival or corneal epithelial defect were evaluated. Based on OSGS, the ocular findings were categorized into grades 0–3. Initial presentation, treatment, and final ocular findings were noted. The ALgorithm of Drug causality for Epidermal Necrolysis (ALDEN) score was used to estimate a causal effect of ICI on SJS/TEN.
Results
A total of 11 patients with ICI-associated SJS/TEN were enrolled (mean age=55.5±9.1 years). Seven had SJS, 1 had SJS/TEN-overlap syndrome, and 3 had TEN. The most prevalent malignancy was adenocarcinoma of the lung (n=4). The ICIs associated with SJS/TEN were nivolumab (n=4), pembrolizumab (n=3), atezolizumab (n=3), durvalumab (n=1), and combined use of ipilimumab and nivolumab (n=1). Eight patients expired during follow-ups. ALDEN scores suggested probable causal effect in 8 patients, and possible causal effect in 3 patients. Ocular manifestations included none (n=4), mild (n=3), severe (n=1), and most severe involvement (n=3), with 2 patients requiring repeated amniotic membrane dressing during acute stage. At the last follow-up, corneal surface integrity was maintained in all patients.
Conclusions
Patients with ICI-induced SJS/TEN had a poor prognosis for survival. Aggressive systemic and local treatment may preserve useful vision and minimize long-term ocular complications, maintaining patients’ quality of life.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.