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Abstract Number: 2137

Overall Survival in Patients with PD-1 Inhibitor-related Inflammatory Arthritis and Metastatic Melanoma

Michael Richter1, Jacob Orme 2, Heidi Finnes 3 and Uma Thanarajasingam 4, 1Division of Rheumatology, University of Washington, Seattle, WA, 2Department of Hematology and Oncology, Mayo Clinic, Rochester, MN, 3Department of Pharmacy, Mayo Clinic, Rochester, 4Mayo Clinic, Rochester, MN

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Cancer treatments, Immunotherapy, inflammatory arthritis and PD-1

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Session Information

Date: Tuesday, November 12, 2019

Session Title: Miscellanous Rheumatic & Inflammatory Disease Poster III: Autoimmune Conditions and Therapies

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: The development of de novo inflammatory arthritis (IA) occurs in 2-4% of all patients with cancer treated with programmed cell death protein 1 (PD-1) inhibitors. (1) Prognosis remains a major concern for managing physicians, particularly given the potential for immunosuppressive medications to impact the anti-tumor response. The objective of this study is to assess the overall survival of patients with melanoma who develop anti-PD-1 associated IA.

Methods: From a database of all patients who received any PD-1 inhibitor at the Mayo Clinic Rochester, Minnesota campus between January 1st, 2011 and May 1st, 2018, we identified those with metastatic melanoma and new-onset inflammatory arthritis using diagnostic codes, search terms, and manual chart review. A Cox proportional hazard model was used to examine overall survival using R statistical software.

Results: Of the 394 patients with stage IV melanoma who received any PD-1 inhibitor, 27 (6.9%) were diagnosed with inflammatory arthritis representing a rheumatic immune-related adverse effect (Rh-irAE). Mean age upon starting anti-PD-1 therapy was 62.4 (SD=13.9) and 39% of patient were female. There were no statistically significant differences in age or sex between patients with and without IA. Average duration of anti-PD-1 therapy was 225 days (SD=279) with no significant differences between groups. IA was most often polyarticular (74%) and was treated with systemic glucocorticoids in 82% of cases for a mean duration of 210 days (SD=221). Six patients (22%) were treated with disease modifying drugs and three patients (11%) required permanent anti-PD-1 discontinuation due to severe symptoms. The development of IA correlated significantly with increased overall survival (HR 0.39, 95% CI=0.19-0.81).

Conclusion: This study shows a significant survival benefit associated with the development of anti-PD-1 associated IA in patients with metastatic melanoma. The prevalence of IA was higher than previous reports on rheumatic irAEs.

  1. Richter MD, Crowson C, Kottschade LA, Finnes HD, Markovic SN, Thanarajasingam U. Rheumatic Syndromes Associated With Immune Checkpoint Inhibitors: A Single-Center Cohort of Sixty-One Patients. Arthritis Rheumatol. 2019;71(3):468-475.

Overall survival based on the development of inflammatory arthritis.Abbreviations: Rh-irAE; rheumatic immune-related adverse effect.


Disclosure: M. Richter, None; J. Orme, None; H. Finnes, None; U. Thanarajasingam, None.

To cite this abstract in AMA style:

Richter M, Orme J, Finnes H, Thanarajasingam U. Overall Survival in Patients with PD-1 Inhibitor-related Inflammatory Arthritis and Metastatic Melanoma [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/overall-survival-in-patients-with-pd-1-inhibitor-related-inflammatory-arthritis-and-metastatic-melanoma/. Accessed April 17, 2021.
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