Risk of Toxicity After Initiating Immune Checkpoint Inhibitor Treatment in Patients With Rheumatoid Arthritis.
Journal
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
ISSN: 1536-7355
Titre abrégé: J Clin Rheumatol
Pays: United States
ID NLM: 9518034
Informations de publication
Date de publication:
01 Oct 2021
01 Oct 2021
Historique:
pubmed:
25
1
2020
medline:
29
9
2021
entrez:
25
1
2020
Statut:
ppublish
Résumé
Immune checkpoint inhibitors (ICIs) are increasingly used to treat advanced cancer. Rheumatoid arthritis (RA) is associated with an increased risk of malignancies; however, patients with RA have been excluded from ICI trials. In this study, we evaluated risk of toxicity after initiation of ICI treatment in RA patients. We conducted a single-institution, medical records review analysis to assess the incidence of immune-related adverse events (irAEs) and autoimmune disease (AID) flares among patients with AIDs treated with ICIs from 2011 to 2018. A subgroup analysis for RA patients was performed with frequencies of irAEs and AID flares reported. Twenty-two patients with RA who were treated with ICI for malignancy were identified. At the time of ICI initiation, 86% had inactive RA disease activity. Immune-related adverse events occurred in 7 (32%) of patients, with 2 (9%) developing grade 3 (i.e., severe) irAEs. Immune checkpoint inhibitors were temporarily discontinued because of irAEs in 5 patients (23%), and permanently in 1 patient. Rheumatoid arthritis flares occurred in 12 patients (55%). Of those, 10 (83%) received oral corticosteroids with an adequate treatment response. Our analysis suggests that irAEs following ICI treatment are not increased among RA patients compared with other cancer patients. Heightened RA disease activity during ICI treatment is common, but most adverse events are manageable with oral corticosteroids, and few require permanent ICI discontinuation. A close collaboration between the oncologist and rheumatologist is advisable when considering ICIs in patients with RA.
Identifiants
pubmed: 31977647
pii: 00124743-202110000-00002
doi: 10.1097/RHU.0000000000001314
pmc: PMC7374048
mid: NIHMS1067466
doi:
Substances chimiques
Immune Checkpoint Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
267-271Subventions
Organisme : NIAMS NIH HHS
ID : R01 AR057781
Pays : United States
Organisme : NIAMS NIH HHS
ID : R01 AR060861
Pays : United States
Organisme : NIAMS NIH HHS
ID : R01 AR065964
Pays : United States
Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
J.W. consults for and has received less than $10,000 per annum from Merck, Genentech, Astra Zeneca, GSK, Novartis, Nektar, Medivation, Celldex, Incyte, and EMD Serono and $10,000 to $25,000 from BMS for membership on Advisory Boards; holds equity in CytoMx, Biond, and Altor; is on a scientific advisory board for Celldex, CytoMx, Incyte, Biond, Protean, CV6, and Sellas; and was named on a patent from Moffitt Cancer Center on an ipilimumab biomarker and a PD-1 patent from Biodesix. The other authors declare no conflict of interest.
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