Psychiatric disorders associated with immune checkpoint inhibitors: a pharmacovigilance analysis of the FDA Adverse Event Reporting System (FAERS) database
Open accessAbstract
Background With the increasing use of immune checkpoint inhibitors (ICIs) for tumour immunotherapy, the immune-related adverse events (irAEs) caused by their collateral effect on the immune system pose a key challenge for the clinical application of ICIs. Psychiatric adverse events are a class of adverse events associated with ICIs that are realistically observed in the real world. We aim to provide a comprehensive study and summary of psychiatric adverse events associated with ICIs. Methods We obtained ICI adverse reaction reports during January 2012–December 2021 from the FDA Adverse Event Reporting System (FAERS) database. ICI reports underwent screening to minimize the influence of other adverse reactions, concomitant medications, and indications for medication use that may also contribute to psychiatric disorders. Disproportionality analysis was performed to find psychiatric adverse events associated with ICIs by comparing ICIs with the full FAERS database using the reporting odds ratio (ROR). Influencing factors were explored based on univariate logistic regression analysis. Finally, the Cancer Genome Atlas (TCGA) pan-cancer transcriptome data were combined to explore the potential biological mechanisms associated with ICI-related pAEs. Findings Reports of psychiatric adverse events accounted for 2.71% of the overall ICI adverse event reports in the FAERS database. Five categories of psychiatric adverse events were defined as ICI-related psychiatric adverse events (pAEs). The median age of reports with ICI-related pAEs was 70 (interquartile range [IQR] 24–95), with 21.54% of reports having a fatal outcome. Cases with indications for lung cancer, skin cancer and kidney site cancer accounted for the majority. The odds of ICI-related pAEs increased in older patients (65–74: OR = 1.44 [1.22–1.70], P < 0.0001: ≥75: OR = 1.84 [1.54–2.20], P < 0.0001). The occurrence of ICI-related pAEs may be related to NOTCH signalling and dysregulation of synapse-associated pathways. Interpretation This study investigated psychiatric adverse events highly associated with ICI treatment, their influencing factors and potential biological mechanisms, which provides a reliable basis for further in-depth study of ICI-related pAEs. However, as an exploratory study, our findings need to be further confirmed in a large-scale prospective study. Funding This work was supported by the Natural Science Foundation of Guangdong Province (2018A030313846 and 2021A1515012593), the Science and Technology Planning Project of Guangdong Province (2019A030317020) and the National Natural Science Foundation of China (81802257, 81871859, 81772457, 82172750 and 82172811). Guangdong Basic and Applied Basic Research Foundation (Guangdong - Guangzhou Joint Fouds) (2022A1515111212). This work was supported by Key Research and Development Projects of Sichuan Science and Technology (2022YFS0221, 2022YFS0074, 2022YFS0156 and 2022YFS0378). Sichuan Provincial People's Hospital Hospital Young Talent Fund (2021QN08).
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Adverse event reporting could be affected by public awareness of certain drug-AE associations, ethnicity, geography, and timing of approval and introduction to the market.
“AE reporting could also be affected by public awareness of certain drug-AE associations, ethnicity, geography, and timing of approval and introduction to the market [35].”
From The real-world safety profile of tirzepatide: pharmacovigilance analysis of the FDA Adverse Event Reporting System (FAERS) database (2024) · cites this paper as [35]
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- Authors
- Zhou, C., Peng, S., Lin, A., Jiang, A., Peng, Y., Gu, T., Liu, Z., Cheng, Q., Zhang, J., & Luo, P.
- Affiliations
- Zhujiang Hospital (CN)
- University of Electronic Science and Technology of China (CN)
- Second Military Medical University (CN)
- First Affiliated Hospital of Zhengzhou University (CN)
- Central South University (CN)
- Corresponding author
- Cheng, Quan
- Zhang, Jian
- Luo, Peng
- ORCID
- Venue
- eClinicalMedicine
- Publisher
- Elsevier BV
- Published
- 2023-05
- Volume
- 59
- Pages
- 101967
- ISSN
- 2589-5370 (ISSN-L)
- PMC
- PMC10149185
- OpenAlex
- W4366712080
- Cited by
- 213
- References
- 59
- Citations by year
- 2026: 51 · 2025: 94 · 2024: 62 · 2023: 6
- FWCI
- 25.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EClinicalMedicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China (81772457, 81802257, 81871859, 82172750, 82172811)
- Natural Science Foundation of Guangdong Province (2018A030313846, 2021A1515012593)
- Science and Technology Planning Project of Guangdong Province (2019A030317020)
- Basic and Applied Basic Research Foundation of Guangdong Province
- Topics
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Life Sciences › Immunology and Microbiology › Immunology › Immunotherapy and Immune Responses
- Keywords
- immune checkpoint inhibitors, immune-related adverse events, psychiatric adverse events, immune-related encephalitis, immune-related dermatitis, immune-related colitis, immune-related endocrinopathy, immune-related pneumonitis, immune-related hypophysitis, immune-related hepatitis, immune-related nephritis
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