It should be noted, patients with underlying autoimmune disorders, especially those in the active stage, are at a higher risk for experiencing flare ups upon initiation of immunotherapy (about 50%-70%). Some patients with autoantibodies and subclinical autoimmune conditions may only become aware of their condition when it clinically manifests after initiating immunotherapy. Thus, patients with a familial history or presenting with potential signs of an underlying autoimmune disease may need to be screened for autoantibodies prior to initiating immunotherapy. PD-1/L1 inhibitor therapy also increases the risk for reactivation compared with CLTA-4 inhibitor therapy. Interestingly, patients on immunosuppressants at the start of immunotherapy regimen have a lower risk of developing irAEs.
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