A0189 - The Epidemiology of Immune Checkpoint-Inhibitor-Induced Esophagitis: A Population-Based Study

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Khaled Alsabbagh Alchirazi, MD

Cleveland Clinic
Cleveland, OH

Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Abdul Mohammed, MD¹, Madhusudhan Sanaka, MD², Prashanthi Thota, MD³
¹Cleveland Clinic, Cleveland, OH; ²Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH; ³Cleveland Clinic, Cleveland, OH

Introduction: Immune checkpoint inhibitor (ICI) induced esophagitis is increasingly recognized as a severe adverse event of ICIs. However, there are limited epidemiological studies with small sample sizes. We aim to utilize a large database to investigate the epidemiology of ICI-induced esophagitis and describe underlying associations.

Methods: A multi-institutional database (Explorys Inc, Cleveland, OH, USA), an aggregate of electronic health record data from 26 US healthcare systems, was surveyed. A cohort of patients on ICIs (nivolumab, pembrolizumab, ipilimumab and atezolizumab) was identified from 2011 to 2022. Subsequently, patients who developed Systematized Nomenclature of Medicine-Clinical Terms diagnosis of esophagitis taking ICIs were selected. The prevalence of ICI-induced esophagitis was calculated, and underlying associations were described.

Results: Of the 70,383,890 patients in the database, we identified 20,200 (0.03%) with a history of ICI use. There were 2430 (12%) patients who developed a new diagnosis of ICI-induced esophagitis at least 1 day of starting ICI therapy. Patients who developed ICI-induced esophagitis were more likely to be Caucasian [OR: 1.32; 95% CI 1.17–1.50] and older than 65 years [OR: 1.14; 95% CI 1.05–1.25]. There was no statistically significant gender-based differences. When compared to patients on ICI therapy who did not develop esophagitis, patients with ICI-induced esophagitis were more likely to have a history of tobacco use [OR: 1.59; 95% CI 1.46–1.74], history of alcohol use [OR: 1.55; 95% CI 1.34–1.81] and obesity [OR: 1.49; 95% CI 1.36–1.64] (table 1). Patients who received Nivolumab [OR: 8.43; 95% CI 7.83–9.07, p< 0.0001], pembrolizumab [OR: 7.97; 95% CI 7.48–8.48, p< 0.0001], ipilimumab [OR: 4.52; 95% CI 3.27–6.23, p= 0.0007] and atezolizumab [OR: 7.92; 95% CI 6.88–9.11, p< 0.0001] had high odds of developing ICI-induced esophagitis (Figure1).

Discussion: This is the largest study evaluating the epidemiology of ICI-induced esophagitis, confirming an increase in esophagitis risk. Patients with ICI-induced esophagitis were more likely to be Caucasian, older than 65, with a history of tobacco and alcohol use, and obese. The risk of esophagitis should be discussed with patients before initiating these agents, and close follow-up with gastroenterologists is needed.

Figure: Figure 1: Prevalence of selected immune checkpoint-inhibitors demonstrating the risk of immune checkpoint-inhibitors induced esophagitis .

Parameter	ICI with Esophagitis n=2,430 (%)	ICI without Esophagitis n=17,770 (%)	OR (95% CI)	p-value
Age
18-65	840 (34%)	6,650 (37%)	0.88 (0.81-0.97)	0.0063
>65	1,610 (66%)	11,230 (63%)	1.14 (1.05-1.25)	0.0033
Sex
Female	1,040 (43%)	7,530 (42%)	1.02 (0.93-1.11)	0.6919
Male	1,390 (57%)	10,250 (58%)	0.98 (0.90-1.07)	0.6535
Race
Caucasian	2,110 (87%)	14,800 (83%)	1.32 (1.17-1.50)	< 0.0001
Non-Caucasian	320 (13%)	2,970 (17%)	0.76 (0.67-0.86)	< 0.0001
Esophagitis Risk Factors
Alcohol abuse	220 (9%)	1,070 (6%)	1.55 (1.34-1.81)	< 0.0001
Smoking history	940 (39%)	5,040 (28%)	1.59 (1.46 -1.74)	< 0.0001
Obesity	750 (31%)	4,090 (23%)	1.49 (1.36-1.64)	< 0.0001

Table: Table 1: Baseline characteristics of patients receiving immune checkpoint-inhibitors. Univariate analysis used to calculate OR. OR; odds ratio, CI; confidence interval, ICI; immune checkpoint-inhibitors.

Disclosures:

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Ahmed Eltelbany indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Madhusudhan Sanaka indicated no relevant financial relationships.

Prashanthi Thota indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi, MD¹, Ahmed Eltelbany, MD, MPH¹, Abdul Mohammed, MD¹, Madhusudhan Sanaka, MD², Prashanthi Thota, MD³. A0189 - The Epidemiology of Immune Checkpoint-Inhibitor-Induced Esophagitis: A Population-Based Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.