Discussion: Ipilimumab, a human monoclonal antibody, is a new immunotherapy drug shown to improve overall survival in patients with unresectable or metastatic melanoma. However, a common side effect of ipilimumab is diarrhea. Literature shows that about 30 percent of patients treated with ipilimumab develop diarrhea. Ipilimumab-induced diarrhea can present with various levels of severity: grade 1 defined as <4 stools per day above baseline, grade 2 as 4-6 stools above baseline, and grade 3/ 4 as >7 stools above baseline. Sigmoidoscopy or colonoscopy may be useful for grade 2 and above, in which treatment should be initiated if colitis is observed. In this case, our patient presented with grade 2 diarrhea, for which sigmoidoscopy revealed pseudomembranous colitis. Traditional first-line treatment of ipilimumab-induced colitis of grade 2 or higher is steroids, while diarrhea refractory to IV steroid is treated with TNF-alpha inhibitors, such as infliximab. Although our patient’s diarrhea did improve on IV steroids, it recurred during two attempts of PO steroid taper. Finally, it was Humira that maintained the diarrhea-free state after treatment with IV steroids.
Conclusions: Because ipilimumab is a relatively new immunotherapy drug, there is limited data on the efficacy of treatment regimens for its side effects. This case highlights the non-traditional use of Humira in addition to steroids for the management of ipilimumab-induced diarrhea.
To cite this abstract:Pan, K; Khan, H; Vega, RM; Hastings, B; Patel, M; Ness, K . TREATMENT OF IPILIMUMAB-INDUCED DIARRHEA IN MELANOMA PATIENT WITH HUMIRA. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 637. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/treatment-of-ipilimumab-induced-diarrhea-in-melanoma-patient-with-humira/. Accessed February 17, 2020.