Comparative safety and effectiveness of TNF inhibitors, IL6 inhibitors and methotrexate for the treatment of immune checkpoint inhibitor-associated arthritis
Authors' conclusion
The treatment of ICI-IA with a biologic DMARD is associated with more rapid arthritis control than with MTX, but may be associated with a shorter time to cancer progression.
Study context
- Population
- Patients with ICI-associated inflammatory arthritis; pre-existing autoimmune disease excluded66 (45%) women
- Participants
- 147 patients
- Exposure
- Tumour necrosis factor inhibitor (TNFi) vs IL6Ri vs methotrexate (MTX) for ICI-IA
- TNFin = 33
- IL6Rin = 42
- MTXn = 72reference
- Outcome
- Time to cancer progression from ICI initiation
Methodological detailsmulticentre, observational, Cox proportional hazard models adjusted for confounders
- Multicentre
- Observational
- Cox proportional hazard models adjusted for confounders
Main finding
As reported in the abstract
Time to cancer progression
Each group vs MTXHazard ratio (95% CI)P value
TNFi
3.27(1.21–8.84)
P = 0.019IL6Ri
2.37(0.94–5.98)
P = 0.055Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Time to arthritis control from DMARD initiationTNFivs MTX | 1.91 (1.06–3.45) | P = 0.032 | |
| Time to arthritis control from DMARD initiationIL6Rivs MTX | 1.66 (0.93–2.97) | P = 0.089 | |
| 0.20.5125Hazard ratio (log scale) |
Cancer progression and arthritis control in melanoma (subgroup)
- Similar results for both cancer progression and arthritis control
Original publication
Comparative safety and effectiveness of TNF inhibitors, IL6 inhibitors and methotrexate for the treatment of immune checkpoint inhibitor-associated arthritis. Ann Rheum Dis. Published 5 April 2023. doi:10.
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