https://orcid.org/0000-0002-8699-6341
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Linda Wu, Matteo Salvatore Carlino, David Alexander Brown, Georgina Venetia Long, Roderick Clifton-Bligh, Rhiannon Mellor, Krystal Moore, Sarah Christina Sasson, Alexander Maxwell Menzies, Venessa Tsang, Jenny Elizabeth Gunton, Response to Letter to the Editor from Hao and Xue: “Checkpoint Inhibitor-associated Autoimmune Diabetes Mellitus Is Characterized by C-Peptide Loss and Pancreatic Atrophy”, The Journal of Clinical Endocrinology & Metabolism, Volume 110, Issue 2, February 2025, Pages e552–e553, https://doi.org/10.1210/clinem/dgae555
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We thank Dr. Xue et al for their interest in our work.
Xue et al have suggested first that our study design could be improved by stratifying patients based on treatment with anti-programmed cell death protein 1 (anti-PD1) and anti-programmed cell death ligand 1 (anti-PDL1) (1). While we agree that identifying any phenotypic differences in checkpoint inhibitor diabetes (CIADM) presentation between the 2 types of immune checkpoint inhibitors, unfortunately this was not possible given the small number of patients treated with anti-PDL1 therapy (2 patients vs 34 patients receiving anti-PD1) (2). In our previously published systematic review of all published CIADM cases, no differences were identified in time of onset of CIADM and severity of presentation between anti-PD1 and anti-PDL1 cases (3). Similarly, a systematic review of 19 randomized controlled trials did not find any significant differences in toxicity between anti-PD1 treated and anti-PDL1 treated cohorts (4).
Second, Xue et al have queried whether COVID-19 has impacted the presentations of CIADM. A case file review identified no COVID-19 infections noted around the time of CIADM diagnosis. There is no identifiable trend in relation to annual incidence of CIADM in relation to pandemic onset, and on further analysis there was no difference in CIADM time of onset or incidence of diabetic ketoacidosis in pre-2020 and post 2020 cases.
