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    Patent Pending

    Immune-Related Adverse Events for GI Toxicity - Colitis

    Grades severity of colitis secondary to immune checkpoint inhibitor therapy.

    INSTRUCTIONS

    Use in adult patients with colitis symptoms that developed while on treatment with immune checkpoint inhibitors.

    When to Use
    Pearls/Pitfalls
    Why Use

    Adult patients with colitis symptoms that developed while on treatment with immune checkpoint inhibitors including agents against PD-1 (i.e., pembrolizumab, nivolumab), PD-L1 (i.e., atezolizumab, avelumab, durvalumab), or CTLA-4 (i.e., ipilimumab).

    • Immune checkpoint inhibitor (ICPi) colitis should be suspected in patients with symptoms of colitis (e.g. change in bowel habits, abdominal pain, blood and mucus in stool, fever, abdominal distension, obstipation, constipation) while on treatment with immune checkpoint inhibitors.

    • May occur at any time during immune checkpoint inhibitor treatment, but is most frequently seen 5-10 weeks following treatment initiation.

    • More frequently seen with anti-CTLA-4 agents, but is also an important adverse event caused by anti-PD-1 and anti-PD-L1 agents.

    • Management of ICPi colitis is based on the grade of colitis.

    ICPi colitis is the most common cause of hospital admissions due to immune related adverse events. This tool aids in the decision to discontinue ICPi, further diagnostic work-up, and immunosuppressant treatment initiation. 

    Increase of <4 stools per day over baseline; mild increase in ostomy output compared with baseline
    +1
    Increase of 4-6 stools per day over baseline; moderate increase in ostomy output compared with baseline
    +2
    Increase of ≥7 stools per day over baseline; incontinence; hospitalization indicated; severe increase in ostomy output compared with baseline; limiting self-care/activities of daily living
    +3
    Life-threatening consequences; urgent intervention indicated
    +4

    Result:

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    Evidence
    Creator Insights
    Dr. Julie R. Brahmer

    About the Creator

    Julie R. Brahmer, MSc, MD, is the co-director of the upper aerodigestive department at Johns Hopkins Medicine in Baltimore, MD. She is also a professor of oncology at Johns Hopkins Medicine. Dr. Brahmer’s primary research is focused on treatment of lung cancer and mesothelioma.

    To view Dr. Julie R. Brahmer's publications, visit PubMed

    Are you Dr. Julie R. Brahmer? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Nazli Dizman, MD
    About the Creator
    Dr. Julie R. Brahmer
    Are you Dr. Julie R. Brahmer?
    Content Contributors
    • Nazli Dizman, MD