Clinical and Biochemical Recovery From Immune Checkpoint Inhibitor–Induced Diabetes With Seroconversion of GAD Antibodies
Lillian Ruiheng Chen, Tim Cooksley, Rupinder Kochhar, Ezhil Jothi Titus Raj, Paul Lorigan, Safwaan AdamOBJECTIVE
Immune checkpoint inhibitors (ICIs) improve outcomes across multiple cancers but may cause immune-related adverse events, including ICI-induced diabetes (ICI-D). ICI-D typically presents abruptly with severe insulin deficiency, and published cases have largely described irreversible loss of endogenous insulin secretion.
RESEARCH DESIGN AND METHODS
We report a novel case of clinical and biochemical recovery of ICI-D.
RESULTS
Following melanoma treatment with ipilimumab plus nivolumab, then nivolumab monotherapy, the patient developed abrupt-onset symptomatic hyperglycemia with mild ketosis and positive GAD and insulin autoantibodies, consistent with ICI-D. The patient subsequently received infliximab for ICI-related arthritis. Insulin requirements progressively declined, allowing discontinuation of insulin therapy. GAD antibodies normalized within ∼2 months and later became undetectable. Urine C-peptide–to–creatinine ratios increased over time, consistent with endogenous insulin secretion.
CONCLUSIONS
Recovery from ICI-D may occur. The temporal association suggests infliximab may have contributed, warranting further study as a potential disease-modifying therapy.