Immunomodulator use, risk factors and management of flares, and mortality for patients with pre-existing rheumatoid arthritis after immune checkpoint inhibitors for cancer
Authors' conclusion
Among patients with pre-existing RA, few changed immunomodulator medications in anticipation of starting ICI, but RA flares occurred in nearly half. RA flares were mostly mild and treated with typical therapies. Seropositivity was associated with RA flare risk. A minority had severe RA flares requiring disruption of ICI, and RA flares were not associated with mortality.
Study context
- Population
- Patients with pre-existing rheumatoid arthritis (RA) (2010 ACR/EULAR criteria) initiating immune checkpoint inhibitors (ICI) for cancer at Mass General Brigham or Dana-Farber Cancer Institute, Boston, MA (2011–2022)of 11,901 ICI initiators
- Participants
- 100 patients
- Outcome
- RA flares after ICI initiation
Methodological detailslandmark analysis at 3 months, Fine and Gray competing risk models, Cox regression
- Landmark analysis at 3 months
- Fine and Gray competing risk models
- Cox regression
Main finding
As reported in the abstract
- RA flares occurred
- 46 %
- Incidence rate per 1000 person-months
- 1.84 (95 % CI 1.30, 2.37)
- Flared within 3 months of baseline
- 31/100
- Grade 1 flares
- 16/46 (35 %)
- Grade 2 flares
- 25/46 (54 %)
- Grade 3 flares
- 5/46 (11 %)
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| RA flare risk by seropositivitySeropositivityvs SeronegativityAccounting for competing risk of death | age-adjusted sdHR 1.95 (95 % CI 1.02–3.71) | |
| Mortality, RA flare in first 3 monthsvs no RA flare (landmark analysis)79 patients who survived at least 3 months · landmark analysis | adjusted HR 1.24 (95 % CI 0.71–2.16) | |
| 0.20.5125Ratio (log scale) |
RA flare severity
- Grade 1
- 16/46 (35 %)
- Grade 2
- 25/46 (54 %)
- Grade 3
- 5/46 (11 %)
- Hospitalisation for RA flare
- 2/46 (4 %)
RA flare risk by seropositivity
- No other baseline factors associated with RA flare, incl. cancer type, disease activity, RA duration, deformities
ICI discontinued/paused due to RA flares
- ICI discontinued/paused due to RA flares
- 9/46 (20 %)
Safety
RA flare requiring hospitalisation
- Required hospitalization
- 2/46 (4 %)
Concomitant irAEs among those who flared
- Concomitant irAEs
- 15/46 (33 %)
ICI discontinued/paused due to RA flares
- ICI discontinued/paused
- 9/46 (20 %)
Original publication
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