ICI exposure implicated in coeliac disease

Exposure to immune checkpoint inhibitors (ICIs) among cancer patients may predispose them to coeliac disease, according to a large real-world study.

Researchers used data from the TriNetX US Collaborative Network and identified adults who had a diagnosis of malignancies for which ICIs are routinely used. ICIs included nivolumab, pembrolizumab, ipilimumab, atezolizumab, durvalumab, tremelimumab, and avelumab. Patients exposed to ICIs were matched to those without ICI exposure using propensity scores based on demographics and autoimmune comorbidities.

The primary outcome was coeliac disease occurring ≥90 days after the index event.

The propensity-score matched cohorts included 158,208 patients each in the ICI-exposed group and unexposed group. Coeliac disease was diagnosed with greater frequency among patients exposed to ICIs than among those who had no exposure to ICIs (0.152 percent vs 0.071 percent).

Exposure to ICIs was associated with around a fourfold increase in the risk of developing coeliac disease (adjusted hazard ratio [aHR], 3.95, 95 percent confidence interval [CI], 3.11–5.03; p<0.001). The corresponding number needed to harm was 1,235.

The increased risk of coeliac disease associated with ICI exposure was consistently observed across sex and age subgroups, including females (aHR, 3.43, 95 percent CI, 2.55–4.62) and males (aHR, 5.36, 95 percent CI, 3.53–8.12), and patients aged >60 years (aHR, 4.24, 95 percent CI, 3.17–5.67).