The Drug-Induced Respiratory Disease Website

Immune checkpoint inhibitors (ICI) - ICI combinatorial Rx

Delayed ILD, -pneumonitis, -fibrosis

Delayed: occurring after termination of treatment

Couey MA, Bell RB, Patel AA, Romba MC, Crittenden MR, Curti BD, Urba WJ, Leidner RS

Delayed immune-related events (DIRE) after discontinuation of immunotherapy: diagnostic hazard of autoimmunity at a distance.

Journal for immunotherapy of cancer 2019 Jul 03;7;165 — 2019 Jul 03 — 165

Mandalà M, Merelli B, Indriolo A, Tondini C

Late-occurring toxicity induced by an immune checkpoint blockade in adjuvant treatment of a stage III melanoma patient.

European journal of cancer (Oxford, England : 1990) 2018 05;95;130-132 — 2018 05 — 130-132

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

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