The purpose of the study was to describe the prevalence, clinical presentation, and management of rheumatic immune‐related adverse effects ( Rh‐irAEs ) from immune checkpoint inhibitor ( ICI ) therapy.
From a database of all patients who received any immune‐checkpoint inhibitor at the Mayo Clinic Rochester, Minnesota ( U.S. ) between January 1st, 2011 and March 1st, 2018, researchers retrospectively identified those with rheumatic immune‐related adverse effects using diagnostic codes, search terms, and manual chart review.
Of the 1,293 patients who received any checkpoint inhibitor, 43 were clinically diagnosed with Rh‐irAEs.
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 26 patients ( 76% ) required glucocorticoids. Mean treatment duration was 18 weeks ( SD 18 weeks ). Five patients (15%) also received disease‐modifying drugs and 3 patients ( 9% ) required discontinuation of ICI therapy.
Myopathy was treated with glucocorticoids in all cases for a mean duration of 15 weeks ( SD 17 weeks ) and lead to two deaths and permanent ICI discontinuation in 9 patients ( 90% ). O
ther syndromes included connective tissue diseases, vasculitis, PMR‐like syndrome, and flared pre‐existing rheumatic disease. Most ( 71% ) were treated with immunosuppression with 12% requiring ICI discontinuation.
In conclusion, the study represents the largest cohort of rheumatic immune‐related adverse effects to date.
Most patients received long courses of immune suppression, though only a minority required immune checkpoint inhibitor discontinuation. ( Xagena )
Richter MD et al. Arthritis Rheumatol 2018;doi:10.1002/art.40745.