Prevalence of Autoimmune Conditions in Metastatic Melanoma Patients Starting Checkpoint Inhibitors

Alexandra Ladouceur¹, Marina Amaral De Avila Machado², Marie Hudson¹, Cristiano Moura³ and Sasha Bernatsky³, ¹McGill University, Montréal, QC, Canada, ²Research Institute of McGill University Health Center, Montréal, QC, Canada, ³Research Institute of the McGill University Health Centre, Montréal, QC, Canada

Meeting: ACR Convergence 2022

Keywords: Administrative Data, autoimmune diseases, immunology

Session Information

Date: Sunday, November 13, 2022

Title: Immunological Complications of Medical Therapy Poster

Session Type: Poster Session B

Session Time: 9:00AM-10:30AM

Background/Purpose: Since patients with pre-existing autoimmune conditions are commonly excluded from clinical trials with immune checkpoint inhibitors (ICI), we aimed to describe the characteristics of ”real-world” patients with pre-existing autoimmune conditions diagnosed with metastatic melanoma and started on ICI.

Methods: Using US administrative health claims data from MarketScan (Jan. 2012-July 2019), we identified a cohort of adults with metastatic melanoma (based on International Classification of Diseases, ICD physician billing or hospitalization diagnostic codes) who started ipilimumab (IPI), pembrolizumab (PEM), nivolumab (NIVO), or IPI/NIVO. Cohort entry was defined as the date of first prescription for one of these drugs. Inclusion criteria required health/drug plan coverage for 12 months before cohort entry. Pre-existing autoimmune conditions were identified, within the 12 months before cohort entry, based on ≥1 ICD physician billing or hospitalization diagnostic code for the condition of interest.

Results: We studied 3409 adults with metastatic melanoma (2071 male). Over a quarter (N=908, 26.6%) had pre-existing autoimmune conditions at baseline. Of these, the most frequent was hypothyroidism (N=380), myopathy and myositis (N=76), type I diabetes mellitus (N=44), rheumatoid arthritis (N=36) and vitiligo (N=24). Pre-existing autoimmune conditions were more frequent in women versus men (31.9% vs 23.2%). From one year to the next, there was no clear increase in the percent of pre-existing autoimmune disease among the newly diagnosed metastatic melanoma patients. There was a non-significant trend towards fewer pre-existing autoimmune conditions in patients treated with combination IPI/NIVO (22%) versus ICI monotherapy (26-28%).

Conclusion: Pre-existing autoimmune conditions are present in a considerable number of metastatic melanoma patients receiving ICI. Combination therapy with IPI/NIVO improves outcomes in metastatic melanoma, though with higher adverse events. Pre-existing autoimmune conditions might be seen by clinicians as a relative contraindication for combination ICI, but this should be evaluated in future studies.

Disclosures: A. Ladouceur, None; M. Amaral De Avila Machado, None; M. Hudson, Bristol-Myers Squibb(BMS), Boehringer-Ingelheim, Mallinckrodt; C. Moura, None; S. Bernatsky, None.

To cite this abstract in AMA style:

Ladouceur A, Amaral De Avila Machado M, Hudson M, Moura C, Bernatsky S. Prevalence of Autoimmune Conditions in Metastatic Melanoma Patients Starting Checkpoint Inhibitors [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/prevalence-of-autoimmune-conditions-in-metastatic-melanoma-patients-starting-checkpoint-inhibitors/. Accessed .

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