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The significance of histological activity measurements in immune checkpoint inhibitor colitis
Author(s) -
Pai Rish K.,
Pai Reetesh K.,
Brown Ian,
Choi WonTak,
Schaeffer David F.,
Farnell David,
Kumarasinghe M. Priyanthi,
Gunawardena Dilini,
Kim Baek Hui,
Friedman Mark,
Ghayouri Masoumeh,
Lauwers Gregory Y.
Publication year - 2021
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.16142
Subject(s) - colitis , microscopic colitis , medicine , gastroenterology , odds ratio , colectomy , adverse effect , ulcerative colitis , biopsy , ischemic colitis , collagenous colitis , colorectal cancer , inflammatory bowel disease , cancer , disease
Summary Background Colitis is a significant complication of immune checkpoint inhibitors (ICI). Currently, clinical and endoscopic severity are used to guide therapy. Aims To investigate associations between clinical, endoscopic, and histological features with outcomes Methods We identified 149 patients from seven institutions with biopsy‐proven ICI colitis. Biopsies were evaluated for histological features including the Geboes score, and the Robarts histopathological index (RHI) was calculated. Clinical, endoscopic, and histological data were tested for associations with biological use and adverse colitis outcomes (biological‐refractory colitis, colectomy or death from colitis). Results Three mutually exclusive histological patterns were identified: acute colitis, chronic active colitis and microscopic colitis. Microscopic colitis was associated with older age (68.5 vs 61 years for acute colitis pattern, P = 0.02) and longer time to colitis (5.5 vs 3 months for the other patterns, P = 0.05). Biological use was associated with earlier time to colitis (2 vs 3 months, P = 0.04) and higher RHI (18 vs 12, P = 0.007). On multivariate analysis, RHI ≥14 was associated with biological use with an odds ratio of 4.5 (95% CI 1.4‐13.8; P = 0.01). Adverse colitis outcomes were associated with shorter time to colitis (2 vs 3 months, P = 0.008) and higher RHI (24 vs 14, P = 0.001). On multivariate analysis, RHI ≥24 was associated with adverse colitis outcomes with an odds ratio 9.5 (95% CI 2.1‐42.3 P = 0.003). Conclusion Histological activity as measured by RHI is the only factor independently associated with biological use and adverse colitis outcomes. Prospective studies are needed to validate these findings to determine if histological activity should be incorporated into therapeutic algorithms.