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. 2018 Dec;48(3):553-557.
doi: 10.1016/j.semarthrit.2018.02.011. Epub 2018 Mar 22.

Clinical presentation of immune checkpoint inhibitor-induced inflammatory arthritis differs by immunotherapy regimen

Laura C Cappelli  1 , Julie R Brahmer  2 , Patrick M Forde  2 , Dung T Le  2 , Evan J Lipson  2 , Jarushka Naidoo  2 , Lei Zheng  2 , Clifton O Bingham 3rd  3 , Ami A Shah  3
Affiliations

Clinical presentation of immune checkpoint inhibitor-induced inflammatory arthritis differs by immunotherapy regimen

Laura C Cappelli et al. Semin Arthritis Rheum. 2018 Dec.

Abstract

Introduction: Immune checkpoint inhibitors (ICIs) are a class of cancer immunotherapy, increasingly utilized to treat malignancies. Inflammatory arthritis (IA) is a potential consequence of ICI use, but there is limited information to guide evaluation and management of this immune-related adverse event (irAE). This study aimed to characterize clinical phenotypes, IA treatment and response in the largest cohort of patients with ICI-induced IA reported to date.

Methods: Patients with rheumatologist-confirmed IA occurring during or after ICI treatment with no prior history of autoimmune disease were included. Data were analyzed by ICI treatment regimen; treatments included combination CTLA-4/PD-1 inhibition, anti-PD-1 or anti-PD-L1 monotherapy. Relationship to the development of other irAEs, management of IA, and outcomes of IA management were evaluated.

Results: Of 30 patients identified, those treated with combination ICI therapy were more likely to present with knee arthritis, to have higher levels of C-reactive protein, to have already had another irAE, and to have a reactive arthritis-like phenotype. In contrast, patients treated with ICI monotherapy were more likely to have initial small joint involvement and to have IA as their only irAE. Ten patients required additional immunosuppression beyond corticosteroids, with TNF-inhibitors and/or methotrexate. Tumor progression while on non-corticosteroid immunosuppression was not seen in those with initial tumor response to ICIs.

Conclusion: These data suggest that distinct IA phenotypes may emerge with exposure to different ICI regimens. The majority of patients referred to rheumatology required systemic immunosuppression to manage their IA symptoms. Tumor progression was not seen in patients requiring TNF-inhibitors.

Keywords: Cancer; Immune checkpoint inhibitor; Immunotherapy; Inflammatory arthritis.

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Figures

Figure 1
Figure 1
a) Time to develop irAE after ICI initiation (time to symptoms for IA, time to diagnosis for others) b) Time to develop IA symptoms and for IA diagnosis in groups by first joint involvement
Figure 1
Figure 1
a) Time to develop irAE after ICI initiation (time to symptoms for IA, time to diagnosis for others) b) Time to develop IA symptoms and for IA diagnosis in groups by first joint involvement
See this image and copyright information in PMC

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