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Meta-Analysis
. 2019 Apr 25;5(1):e000906.
doi: 10.1136/rmdopen-2019-000906. eCollection 2019.

Polymyalgia rheumatica-like syndrome from checkpoint inhibitor therapy: case series and systematic review of the literature

Cassandra Calabrese  1 , Laura C Cappelli  2 , Marie Kostine  3 , Elizabeth Kirchner  1 , Tawnie Braaten  2 , Leonard Calabrese  1
Affiliations
Meta-Analysis

Polymyalgia rheumatica-like syndrome from checkpoint inhibitor therapy: case series and systematic review of the literature

Cassandra Calabrese et al. RMD Open. .

Abstract

Objective: To assess whether the polymyalgia rheumatica (PMR)-like syndrome reported as an immune related adverse event (irAE) from checkpoint inhibitor therapy is consistent with the 2012 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) provisional criteria for PMR.

Methods: The cases were derived from two sources. Group 1 represents reported cases from three contributing centres. Group 2 was derived from a systematic review of the literature searching for all cases reported as PMR or PMR-like illness associated with checkpoint inhibitor therapy. Cases were assessed for the quality of reporting and then analysed to determine whether they fulfilled the 2012 EULAR/ACR provisional criteria for PMR.

Results: A total of 49 patients were included for analysis. Among the entire group, 37 (75%) were designated 'complete' indicating that they had sufficient data to reliably apply the 2012 EULAR/ACR criteria. 28 (75%) cases fulfilled complete criteria for PMR. A number of cases also demonstrated some clinical features unusual for idiopathic PMR.

Conclusion: This study suggests a high proportion of reported cases of checkpoint inhibitor-related PMR fulfil preliminary criteria for PMR, yet in one quarter clinical details were incomplete making verification problematic. Furthermore, in the absence of a gold standard for the diagnosis of PMR, the relationship of checkpoint inhibitor-related PMR to the idiopathic form remains unclear.

Keywords: autoimmune diseases; inflammation; polymyalgia rheumatica.

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Conflict of interest statement

Competing interests: CC speaks for Regeneron/Sanofi. LCC received a research grant from Bristol-Myers Squibb and consults for Regeneron/Sanofi. MK consults for Bristol-Myers-Squibb. TB is a fellow supported by T32 grant. EK consults for Celgene, Horizon, Novartis, Regeneron and speaks for Merck and Sanofi. LC consults for Bristol-Myers-Squibb, Genentech and Astra-Zeneca.

References

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