Global safety profile of PD-1/PD-L1 inhibitors in hepatic autoimmune disorders: A global disproportionality analysis

The increasing use of programmed cell death protein-1 (PD-1) and programmed death-ligand 1 (PD-L1) inhibitors in cancer therapy has raised concerns regarding immune-related adverse events. However, global pharmacovigilance studies on autoimmune diseases remain scarce. This study aimed to evaluate the signal detection between PD-1/PD-L1 inhibitors and hepatic autoimmune disorders. A global pharmacovigilance study was conducted using data from individual case safety reports. The analysis centered on PD-1/PD-L1 inhibitors, classified by Anatomical Therapeutic Chemical codes (e.g., atezolizumab, avelumab, budigalimab, cemiplimab, dostarlimab, durvalumab, nivolumab, pembrolizumab, sintilimab, spartalizumab, and tislelizumab). Hepatic autoimmune disorders were defined based on MedDRA Version 26.0 (Maintenance and Support Services Organization, McLean). Disproportionality analyses were performed using reporting odds ratios with 95% confidence intervals and information components (ICs), with IC0.25, to evaluate potential signal detection. A total of 1401 reports of hepatic autoimmune disorders associated with PD-1/PD-L1 inhibitors were identified. Nivolumab (59.89%) and pembrolizumab (27.62%) accounted for the highest reports. Notably, nivolumab (reporting odds ratio, 117.52 [95% confidence interval, 109.52-126.10]; IC, 6.67 [IC0.25, 6.60]) and pembrolizumab (55.69 [50.31-61.64]; 5.65 [5.55]) showed the notable reporting signals, followed by cemiplimab, atezolizumab, durvalumab, avelumab, sintilimab, and tislelizumab. Subgroup analysis showed a stronger signal for hepatic autoimmune disorders in males than in females treated with PD-1/PD-L1 inhibitors. Additionally, the mean time to onset was 22.90 days (standard deviation: 81.66), although some reports presented with substantially delayed onset. Most PD-1/PD-L1 inhibitors showed pharmacovigilance signals for hepatic autoimmune disorders, particularly nivolumab and pembrolizumab. Although our findings do not permit causal inference, these findings underscore the necessity for sustained hepatic monitoring, risk stratification, and appropriate therapeutic management.