Clinical Patterns and Follow-Up of Inflammatory Arthritis and Other Immune-Related Adverse Events Induced by Checkpoint Inhibitors. A Multicenter Study
Gómez-Puerta, José A. (Universitat de Barcelona. Departament de Medicina)
Lobo-Prat, David (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Pérez-García, Carolina (Hospital del Mar (Barcelona, Catalunya))
Ponce, Andrés (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Frade-sosa, Beatriz (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Millán Arciniegas, Ana Milena (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Ojeda, Fabiola (Hospital del Mar (Barcelona, Catalunya))
Ruiz-Esquide, Virginia (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Corominas, Hèctor (Institut d'Investigació Biomèdica Sant Pau)

Date:	2022
Abstract:	Objectives: To describe different clinical patterns of rheumatic immune-related adverse events (irAEs) induced by immune checkpoint inhibitors (ICI) and their rheumatic and oncologic outcomes. Methods: We classified clinical syndromes according to five different categories: non-inflammatory arthralgias (NIA), rheumatoid arthritis (RA)-like, psoriatic arthritis (PsA)-like, polymyalgia rheumatica (PMR)-like, and a miscellaneous group of patients with other syndromes. We conducted a baseline visit and then follow-up in order to determine their clinical pattern, treatment response, and outcome. Results: We included 73 patients (64% male) with a mean age of 66. 1 ± 11. 6 years. Main underlying diagnosis was lung carcinoma in 29 (39%) patients, melanoma in 20 (27%), and renal-urothelial cancer in 11 (15%). Main ICI included Pembrolizumab in 24 (32%), Nivolumab 17 (23%), and Atezolizumab 7 (9 %). Seventeen out of seventy-three patients had an underlying rheumatic disease before ICI treatment. Fourteen patients developed other irAEs before or simultaneously with rheumatic syndromes. Main rheumatic irAEs included: RA-like in 31 (42. 4%), NIA in 19 (26. 0%), PMR-like in 10 (13. 7%), and PsA-like in 5 (6. 8%), among others. Median time from ICI to irAEs was 5 months (IQR 3-9). Those patients who received combined therapy, had a trend for an earlier presentation than those who received monotherapy (4. 3 months IQR 1. 85-17 vs. 6 months IQR 3-9. 25, p = NS). Mean follow-up time was 14. 0 ± 10. 8 (SD, months). At the last visit, 47 % were taking glucocorticoids and 11% DMARD therapy. At the last visit, 13 (17. 8%) patients remained with persistent arthritis, 19 (26%) had intermittent flares, and 39 (53. 4%) had a self-limited pattern. Only in 15. 1% of patients ICI therapy was discontinued. Conclusions: We described different patterns according to treatment and irAEs. Combined ICI therapy had an earlier onset of symptoms. Patients who presented as RA-like, had a higher risk of persistent arthritis. After a mean follow-up of more than 1 year, one-fifth of the patients remained with persistent arthritis and 11% required DMARD therapy.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Immunotherapy ; Adverse (side) effects ; Checkpoint ; Arthritis ; Polymyalgia rheumatica
Published in:	Frontiers in Medicine, Vol. 9 (June 2022) , p. 888377, ISSN 2296-858X

DOI: 10.3389/fmed.2022.888377
PMID: 35783644

8 p, 696.1 KB

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