Drug-Induced Graves Disease From CTLA-4 Receptor Suppression
Abstract
Monoclonal antibody, ipilimumab, useful for treatment of metastatic melanoma, blocks CTLA-4 mediated T-cell suppression and can also cause a Graves ophthalmopathy like syndrome. Epidemiologic study has linked variant polymorphisms of CTLA-4 receptor gene to the presence of thyroid eye disease. The combination of these observations suggests CTLA-4 mediated T-cell functions are important to the pathogenesis of thyroid-associated eye disease.
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In the literature, only nine cases of ICPi-induced Graves' hyperthyroidism and seven cases of induced Graves' orbitopathy have been described, associated with anti-PD-1 or anti-CTLA-4 treatment or their combination, with only one patient presenting both thyrotoxicosis and orbitopathy.
“To the best of our knowledge at the time of writing, only nine cases of ICPi-induced Graves’ hyperthyroidism and seven cases of induced Graves’ orbitopathy have been described in the literature, associated with anti-PD-1 or anti-CTLA-4 treatment or their combination (Table 3), with only one patient presenting with both thyrotoxicosis and orbitopathy [19,29,30,31,35,36,37,38,39,40,41,42,43,44].”
From Graves’ Disease during Immune Checkpoint Inhibitor Therapy (A Case Series and Literature Review) (2021) · cites this paper as [31]
Initially only induced Graves' orbitopathy without thyrotoxicosis were described in patients undergoing Ipilimumab treatment.
“In the literature, initially only induced Graves’ orbitopathy (GO) without thyrotoxicosis were described in patients undergoing Ipilimumab (anti-CTLA-4) treatment [29,30,31].”
From Graves’ Disease during Immune Checkpoint Inhibitor Therapy (A Case Series and Literature Review) (2021) · cites this paper as [31]
HLA haplotypes associated with classic type 1 diabetes (DR3-DQ2 and DR4-DQ8) and with fulminant diabetes in Asian populations (DR4-DQ4 and DR9-DQ9) are over-represented among patients with immune checkpoint inhibitor-associated diabetes mellitus.
“Human leukocyte antigen (HLA) haplotypes linked with classic T1D (DR3-DQ2 and DR4-DQ8) and fulminant diabetes in the Asian population (DR4-DQ4 and DR9-DQ9) are over-represented among ICI-DM patients68”
From Endocrine toxicities of immune checkpoint inhibitors (2021) · cites this paper as [68]
Cases of immune checkpoint inhibitor-associated diabetes mellitus in patients on CTLA-4 monotherapy are very rare.
“whereas reports of cases on CTLA-4 monotherapy are very rare”
From Endocrine toxicities of immune checkpoint inhibitors (2021) · cites this paper as [68]
About 97% of reported cases of immune checkpoint inhibitor-associated diabetes mellitus have occurred in patients treated with anti-PD-1/PD-L1 agents or combination therapy.
“Approximately 97% of all reported ICI-DM cases have arisen with anti-PD-1/PD-L1 or combination treated patients”
From Endocrine toxicities of immune checkpoint inhibitors (2021) · cites this paper as [68]
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Targeted Therapy and Their Ocular Complications
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- Authors
- Borodic, G., Hinkle, D. M., & Cia, Y.
- Affiliations
- Massachusetts Eye and Ear Infirmary (US)
- Harvard University (US)
- Corresponding author
- Borodic, Gary
- ORCID
- Hinkle, David M.
- Venue
- Ophthalmic Plastic & Reconstructive Surgery
- Published
- 2011-07
- Volume
- 27
- Issue
- 4
- Pages
- e87-e88
- ISSN
- 0740-9303 (ISSN-L)
- OpenAlex
- W1988822265
- Cited by
- 120
- References
- 6
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 9 · 2020: 9 · 2019: 13 · 2018: 13 · 2017: 7 · 2016: 13 · 2015: 10 · 2014: 4 · 2013: 10 · 2012: 2
- FWCI
- 3.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Ophthalmic Plastic and Reconstructive Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Ophthalmology › Drug-Induced Ocular Toxicity
- Keywords
- ipilimumab, CTLA-4 blockade, Graves' ophthalmopathy, T cell suppression, metastatic melanoma, CTLA-4 gene polymorphism, autoimmune thyroid disease
- MeSH terms
- Ipilimumab, Antibodies, Monoclonal, Antineoplastic Agents, Diplopia, Exophthalmos, Female, Humans, Lung Neoplasms, Magnetic Resonance Imaging, Melanoma, Middle Aged, Neoplasms, Unknown Primary, Oculomotor Muscles, Antigens, CD, Graves Ophthalmopathy, CTLA-4 Antigen
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