Targeted monoclonal antibodies to CTLA-4 (T-lymphocyte antigen-4, CD152) have shown promise in the treatment of malignant melanoma and other tumors, but may be complicated by autoimmune diseases.
Monoclonal antibodies affected include:
(1) ipilimumab (Yervoy)
(2) tremelimumab
Mechanism: unrestrained T-cell activation
Autoimmune disorders reported include:
(1) rash, including toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome
(2) enterocolitis
(3) hypophysitis
(4) other endocrinopathy (adrenal insufficiency, hyper- or hypo-thyrodism)
(5) autoimmune hepatitis
(6) autoimmune pancreatitis
(7) iridocyclitis
(8) lymphadenopathy
(9) nephritis
(10) neuropathy, Guillain-Barre syndrome or myasthenia gravis
It would be interesting to see if these agents are contra-indicated in a patient with a a past history of autoimmune disease.
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