Mortality and immune-related adverse events after immune checkpoint inhibitor initiation for cancer among patients with pre-existing rheumatoid arthritis: a retrospective, comparative, cohort study
An erratum to this article was published (Lancet Rheumatol, May 2023 ↗)
Main finding · DeathResult — go to the resultAdjusted hazard ratio 1.16 95% CI 0.86–1.57Authors' conclusion
Patients with pre-existing rheumatoid arthritis initiating immune checkpoint inhibitors had similar risk of mortality and severe immune-related AEs as matched comparators. Although patients with pre-existing rheumatoid arthritis were more likely to have immune-related AEs, this finding was mostly due to mild rheumatoid arthritis flares.
Study context
- Population
- Patients initiating ICIs for cancer, April 1, 2011, to April 21, 2021, Mass General Brigham and Dana-Farber Cancer Institute, Boston, USA (median age 71.2 years)matched cohort
- Participants
- 290 patients
- Exposure
- Pre-existing RA vs matched non-RA comparators initiating ICIs
- RAn = 87
- Comparatorsn = 203reference
- Outcome
- Co-primary: time from index date to death and time to the first immune-related AE
Methodological detailscomparative, matched (up to 1:3) by sex, calendar year, ICI target, and cancer type and stage, adjusted Cox proportional hazards model
- Comparative
- Matched (up to 1:3) by sex, calendar year, ICI target, and cancer type and stage
- Adjusted Cox proportional hazards model
Main finding
Death
Adjusted hazard ratio
1.16
95% CI 0.86–1.57
P = 0.34
Events by group
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | RA | Comparators | aHR (95% CI) | P value | |
|---|---|---|---|---|---|
| Co-primary: any all-grade irAE | 61% | 49% | 1.72 (1.20–2.47) | P = 0.0032 | |
| 0.512Adjusted hazard ratio (log scale) |
Safety
RA flares (RA) vs inflammatory arthritis (comparators)
P < 0.0001
Rash or dermatitis
P = 0.048
Endocrinopathy
P = 0.0078
Colitis or enteritis
P = 0.094
Hepatitis
P = 0.043
| Outcome | RA | Comparators |
|---|---|---|
| Grade 5 irAEs (deaths) due to myocarditis | — not stated in the abstract | 1% |
— not stated in the abstract
Grade 5 irAEs (deaths) due to myocarditis
- Both grade 5 irAEs in the comparator group
Original publication
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