Researchers Identify Risk of Immunotherapy-Related Toxicity in Rheumatoid Arthritis
Patients with rheumatoid arthritis (RA) who receive treatment with immune checkpoint inhibitors for malignancy appear to have similar rates of severe immune-related adverse events (irAEs) as those without autoimmune diseases, depending on the medication used, according to new research presented at the 2019 American College of Rheumatology (ACR)/Association of Rheumatology Professionals (ARP) Annual Meeting.
“The punchline here is basically that patients with RA should not be excluded from standard-of-care malignancy treatment such as immune checkpoint inhibitor therapy,” study coauthor Sabina Sandigursky, MD, an instructor of medicine at New York University School of Medicine/NYU Langone Health, said during a press conference.
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Some patients with RA receive treatment with immune checkpoint inhibitors. However, the risks of toxicity and/or disease flare are not clearly outlined.
To study this, Dr Sandigursky and colleagues conducted a single-institution retrospective analysis with data of 84 patients with preexisting autoimmune diseases.
Of the patients, 22 had RA. Of these, 16 were women, and 20 had no evidence of active disease. A total of 16 patients were receiving RA immunomodulatory therapy at the start of immune checkpoint inhibitor therapy, with 8 patients receiving systemic corticosteroids and 7 patients on methotrexate.
Malignant conditions among the patients included melanoma in 7 patients, non–small cell lung cancer in 7 patients, and others. A total of 13 patients with malignant conditions were treated with pembrolizumab, 9 patients were treated with nivolumab, and 4 patients were treated with ipilimumab.
Results showed that 9 patients developed toxicity of any grade. A total of 7 patients experienced IrAEs, with only 2 of them developing grade 3 irAEs. The most common toxicities were dermatitis and colitis.
Five patients temporarily discontinued immune checkpoint inhibitor therapy because of irAEs, of whom 1 required permanent discontinuation.
“Fifty percent of patients had a flare of their preexisting RA,” Sandigursky said. “These patients experienced immune-related adverse events distinct from RA symptoms, but [they] were not indications to discontinue treatment with immunotherapy.”
Most patients with RA flare received treatment with oral corticosteroids. One patient permanently discontinued immune checkpoint inhibitor therapy because of flare.
A total of 16 patients experienced flare, an irAE, or both.
The median OS for patients with RA after the start of immune checkpoint inhibitor therapy was 10.5 months.
“[This study] is important because as we know, RA patients have a higher risk for malignancy,” Sandigursky said. “We need to know what will happen to them in the future.”
—Melinda Stevens
Reference:
Efuni E, Cytryn S, Boland P, Sandigursky S. Risk of immunotherapy related toxicity in patients with rheumatoid arthritis [abstract 1339]. Arthritis Rheumatol. 2019;71(suppl 10). Presented at: 2019 ACR/ARP Annual Meeting; November 8-13, 2019; Atlanta, GA. https://acrabstracts.org/abstract/risk-of-immunotherapy-related-toxicity-in-patients-with-rheumatoid-arthritis/. Accessed November 12, 2019.