Session Information
Date: Monday, November 13, 2023
Title: (1052–1081) Immunological Complications of Medical Therapy Poster
Session Type: Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Immune checkpoint inhibitors (ICI) are a revolutionary treatment that boost a patient’s own immune system to fight cancer. However, activation of the immune system often induces off-target immune-related adverse events (irAEs). ICI-induced inflammatory arthritis (ICI-IA) affects about 5% of ICI recipients and can lead to ICI discontinuation which might potentially negatively affect tumor outcomes. We aimed 1) to characterize the evolution of ICI-IA while ICI treatment is maintained and 2) to assess how ICI-IA influences ICI management across time.
Methods: All ICI-treated patients referred to rheumatology at Bordeaux University Hospital were identified and patients with ICI-IA defined by either the presence of at least one synovitis on physical exam and/or on imaging or polymyalgia rheumatica (PMR)-like symptoms with a follow-up of ≥ 6 months after ICI-IA onset were included. Charts were manually reviewed to extract data on baseline characteristics, investigations, management and both ICI-IA and tumor outcomes.
Results: Out of 281 referred patients, 80 fulfilled the inclusion criteria, of which 49 (61.3%) were male. The median duration follow-up after ICI-IA onset was 108 weeks [ranging from 26-330 weeks]. The most common tumor was melanoma (n=38, 47.5%), followed by lung cancer (n=16, 20.0%). The mean time from ICI-IA onset to ICI-IA treatment was 8.6 weeks and ICI was continued in 63 patients (78.8%) or temporary held in 11 (13.8%). Prednisone was prescribed in 74 patients (92.5%), csDMARDs in 22 (27.5%) and biologics in 2 (2.5%). ICI-IA resolved allowing ICI-IA treatment discontinuation in 27 patients (33.8%) while still being treated with ICI. Among those, 26 (96.3%) were treated with prednisone (median maximal dose 15 mg and median duration 52.0 weeks), 3 (11.1%) with csDMARDs and 1 (3.7%) with biologics. In patients with persistent ICI-IA while on ICI, 20 (40%) and 34 (68%) had resolved at 6 and 12 months post ICI discontinuation, respectively. During follow-up, the main reason for ICI discontinuation was a cancer stable or in remission in 31 patients (38.8%), cancer progression in 22 (27.5%), other irAE in 7 (8.8%) and ICI-IA in 4 (5.0%). Of note, ICI-IA treatment and ICI management were similar between those with active arthritis and those with resolved arthritis at 6 and 12 months post ICI discontinuation.
Conclusion: In this cohort, ICI was safely continued in most patients experiencing ICI-IA. Over one third of ICI-IA resolved despite maintaining active ICI treatment allowing arthritis treatment discontinuation. Larger studies are needed to determine predicting factors of resolving ICI-IA as this could help minimize exposure to immunosuppressive treatment.
To cite this abstract in AMA style:
Ladouceur A, Barnetche T, Mary-Prey S, Dutriaux C, Gerard E, Pham-Ledard A, Beylot-Barry M, Zysman M, Veillon R, Domblides C, Daste A, Gross-Goupil M, Sionneau B, Lefort F, Larroquette M, Richez C, Truchetet M, Schaeverbebke T, Kostine M. Resolution of Immune Checkpoint Inhibitors-Induced Inflammatory Arthritis While Maintaining Active Treatment with Checkpoint Inhibitors [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/resolution-of-immune-checkpoint-inhibitors-induced-inflammatory-arthritis-while-maintaining-active-treatment-with-checkpoint-inhibitors/. Accessed .« Back to ACR Convergence 2023
ACR Meeting Abstracts - https://acrabstracts.org/abstract/resolution-of-immune-checkpoint-inhibitors-induced-inflammatory-arthritis-while-maintaining-active-treatment-with-checkpoint-inhibitors/