ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1516

Clinical Phenotypes and Treatment of Rheumatic Immune-Related Adverse Events from Checkpoint Inhibitors: A Retrospective Cohort of 112 Patients

Tiphaine Lenfant1, Yuxuan Jin2, Elizabeth Kirchner3, Pauline Funchain2, Jung-Min Song2, Moshe Ornstein2, Laura Wood2, Donald Eicher2, Rula Hajj-Ali4, Leonard Calabrese2 and Cassandra Calabrese5, 1Institut Mutualiste Montsouris, Paris, France, 2Cleveland Clinic, Cleveland, OH, 3CCF, Cleveland, OH, 4Cleveland Clinic, Hunting Valley, OH, 5Cleveland Clinic Foundation, Cleveland Heights, OH

Meeting: ACR Convergence 2021

Keywords: , ,

Session Information

Date: Tuesday, November 9, 2021

Title: Immunological Complications of Therapy Poster (1516–1529)

Session Type: Poster Session D

Session Time: 8:30AM-10:30AM

Background/Purpose: To describe a single center cohort of rheumatic immune related adverse events (irAEs) observed in patients treated with checkpoint inhibitor therapy (ICI) and to identify potential risk factors for persistent rheumatic disease activity.

Methods: Patients referred to the Cleveland Clinic Department of Rheumatic and Immunologic Diseases for rheumatic irAE were retrospectively included and assessed via chart review (2015-2020). Persistent rheumatic irAE was defined as still requiring treatment for rheumatic irAE at last follow-up.

Results: A total of 112 patients (median age 60 years) were identified. The most common irAE clinical phenotypes included inflammatory arthritis (IA, n=46), sicca syndrome (n=21), and polymyalgia rheumatica (n=19). In the entire cohort ICI therapy was held temporarily for rheumatic irAE in 15 patients (13%) for toxicity and permanently discontinued in 26 (23%). At last follow-up, rheumatic irAE had resolved in 41 patients (37%), whereas 71 patients still required treatment of rheumatic irAE (median follow-up 15 months, range 5-30 months). Among therapies administered for irAE, glucocorticoids (GC) were most commonly prescribed (n=78, 70%), followed by hydroxychloroquine (16%), methotrexate (14%), and anti-IL-6 agents (11%). Patients with persistent rheumatic irAE activity more frequently received GC (p=0.018) and had IA (p=0.02) compared to patients that had resolution of irAE. In multivariate analysis, IA patients were at higher risk of persistent rheumatic irAE (OR 3.5 [1.3-10], p=0.014). The overall mortality rate was 27% (n=30). Risk factors for mortality included tumor progression (OR 15.3 [4-65], p< 0.001) and continued treatment with GC at the last follow-up (OR 5.8 [1.5-29], p=0.016). In a survival analysis, continued GC at the end of follow-up was significantly associated with mortality (HR 4.0 [1.3-12], p=0.0001).

Conclusion: In this single-center retrospective cohort of rheumatic irAEs patients, the presence of ICI-related IA was associated with persistent rheumatic disease activity.

Figure 1. Treatment of rheumatic irAEs Colchi: colchicine; GC: glucocorticoids; HCQ: hydroxychloroquine; Infl. A: inflammatory arthritis; IA: intra-articular; IL6-i: interleukin 6 inhibitors; MTX: methotrexate; RTX: rituximab;

Disclosures: T. Lenfant, None; Y. Jin, None; E. Kirchner, Sanofi, 12, Speaker's training, did not speak for company., Novartis, 1, Janssen, 1; P. Funchain, BMS, 5, Pfizer, 5; J. Song, None; M. Ornstein, Bristol Myers Squibb, 1, 2, 5, Merck, 2, Pfizer, 2, 5; L. Wood, Bristol Myers Squibb, 6, EMD Serono, 6, Merck, 6, Pfizer, 6; D. Eicher, None; R. Hajj-Ali, Novartis, 6, Rockpointe, INC., 6, Projects In Knowledge, 6, UpToDate, 9; L. Calabrese, Lilly, 2, BMS, 2, Genentech, 2; C. Calabrese, Sanofi-Regeneron, 2, 6.

To cite this abstract in AMA style:

Lenfant T, Jin Y, Kirchner E, Funchain P, Song J, Ornstein M, Wood L, Eicher D, Hajj-Ali R, Calabrese L, Calabrese C. Clinical Phenotypes and Treatment of Rheumatic Immune-Related Adverse Events from Checkpoint Inhibitors: A Retrospective Cohort of 112 Patients [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/clinical-phenotypes-and-treatment-of-rheumatic-immune-related-adverse-events-from-checkpoint-inhibitors-a-retrospective-cohort-of-112-patients/. Accessed .

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