Rheumatic Syndromes Associated With Immune Checkpoint Inhibitors: A Single‐Center Cohort of Sixty‐One Patients. Issue 3 (28th January 2019)

• Record Type: Journal Article
• Authors: Richter, Michael D.; Crowson, Cynthia; Kottschade, Lisa A.; Finnes, Heidi D.; Markovic, Svetomir N.; Thanarajasingam, Uma
• Is Part Of: Arthritis & rheumatology. Volume 71:Issue 3(2019)
• Page Start: 468
• Page End: 475
• Publication Date: 2019-01-28
• Subjects: Arthritis -- Periodicals; Rheumatism -- Periodicals; 616.72
• DOI: 10.1002/art.40745
• Languages: English
• ISSNs: 2326-5191

Abstract

Abstract : Objective: To describe the prevalence, clinical presentation, and management of rheumatic immune‐related adverse effects (Rh‐irAEs) from immune checkpoint inhibitor (ICI) therapy. Methods: From a database of all patients who received any ICI at the Mayo Clinic Rochester, Minnesota campus between January 1, 2011 and March 1, 2018, we retrospectively identified those with Rh‐irAEs, using diagnostic codes, search terms, and manual chart review. Results: Of the 1, 293 patients who received any ICI, Rh‐irAEs were clinically diagnosed in 43. Eighteen patients with Rh‐irAEs who received ICI therapy elsewhere were also analyzed. Clinical syndromes included inflammatory arthritis (n = 34 [prevalence 2%]), myopathy (n = 10), and other rheumatic syndromes (n = 17). Inflammatory arthritis was most commonly polyarticular, and glucocorticoid treatment was required in 26 patients (76%). The mean ± SD duration of treatment was 18 ± 18 weeks. Five patients (15%) also received disease‐modifying antirheumatic drugs, and ICI therapy had to be discontinued in 3 patients (9%). Myopathy was treated with glucocorticoids in all cases (mean ± SD treatment duration 15 ± 17 weeks) and led to 2 deaths and permanent ICI discontinuation in 9 patients (90%). Other syndromes included connective tissue diseases, vasculitis, polymyalgia rheumatica–like syndrome, and flare of preexisting rheumatic disease. Most (71%) were treated with immunosuppression, with 12% requiring ICI discontinuation. Conclusion: This study represents the largest cohort of patients with Rh‐irAEs reported to date. Most patients received long courses of immunosuppressive treatment, although discontinuation of ICI therapy was required in only a minority.