Clinical Patterns and Follow-Up of Inflammatory Arthritis and Other Immune-Related Adverse Events Induced by Checkpoint Inhibitors. A Multicenter Study
ObjectivesTo describe different clinical patterns of rheumatic immune-related adverse events (irAEs) induced by immune checkpoint inhibitors (ICI) and their rheumatic and oncologic outcomes.MethodsWe classified clinical syndromes according to five different categories: non-inflammatory arthralgias (...
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.888377/full |
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| author | José A. Gómez-Puerta José A. Gómez-Puerta David Lobo-Prat Carolina Perez-García Andrés Ponce Beatriz Frade-sosa Ana Milena Millán Arciniegas Fabiola Ojeda Virginia Ruiz-Esquide Hector Corominas |
| author_facet | José A. Gómez-Puerta José A. Gómez-Puerta David Lobo-Prat Carolina Perez-García Andrés Ponce Beatriz Frade-sosa Ana Milena Millán Arciniegas Fabiola Ojeda Virginia Ruiz-Esquide Hector Corominas |
| author_sort | José A. Gómez-Puerta |
| collection | DOAJ |
| description | ObjectivesTo describe different clinical patterns of rheumatic immune-related adverse events (irAEs) induced by immune checkpoint inhibitors (ICI) and their rheumatic and oncologic outcomes.MethodsWe classified clinical syndromes according to five different categories: non-inflammatory arthralgias (NIA), rheumatoid arthritis (RA)-like, psoriatic arthritis (PsA)-like, polymyalgia rheumatica (PMR)-like, and a miscellaneous group of patients with other syndromes. We conducted a baseline visit and then follow-up in order to determine their clinical pattern, treatment response, and outcome.ResultsWe included 73 patients (64% male) with a mean age of 66.1 ± 11.6 years. Main underlying diagnosis was lung carcinoma in 29 (39%) patients, melanoma in 20 (27%), and renal-urothelial cancer in 11 (15%). Main ICI included Pembrolizumab in 24 (32%), Nivolumab 17 (23%), and Atezolizumab 7 (9 %). Seventeen out of seventy-three patients had an underlying rheumatic disease before ICI treatment. Fourteen patients developed other irAEs before or simultaneously with rheumatic syndromes. Main rheumatic irAEs included: RA-like in 31 (42.4%), NIA in 19 (26.0%), PMR-like in 10 (13.7%), and PsA-like in 5 (6.8%), among others. Median time from ICI to irAEs was 5 months (IQR 3–9). Those patients who received combined therapy, had a trend for an earlier presentation than those who received monotherapy (4.3 months IQR 1.85–17 vs. 6 months IQR 3–9.25, p = NS). Mean follow-up time was 14.0 ± 10.8 (SD, months). At the last visit, 47 % were taking glucocorticoids and 11% DMARD therapy. At the last visit, 13 (17.8%) patients remained with persistent arthritis, 19 (26%) had intermittent flares, and 39 (53.4%) had a self-limited pattern. Only in 15.1% of patients ICI therapy was discontinued.ConclusionsWe described different patterns according to treatment and irAEs. Combined ICI therapy had an earlier onset of symptoms. Patients who presented as RA-like, had a higher risk of persistent arthritis. After a mean follow-up of more than 1 year, one-fifth of the patients remained with persistent arthritis and 11% required DMARD therapy. |
| first_indexed | 2024-04-12T14:01:34Z |
| format | Article |
| id | doaj.art-f8de84ff33164c8e8b83667335f75ddd |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-12T14:01:34Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-f8de84ff33164c8e8b83667335f75ddd2022-12-22T03:30:11ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-06-01910.3389/fmed.2022.888377888377Clinical Patterns and Follow-Up of Inflammatory Arthritis and Other Immune-Related Adverse Events Induced by Checkpoint Inhibitors. A Multicenter StudyJosé A. Gómez-Puerta0José A. Gómez-Puerta1David Lobo-Prat2Carolina Perez-García3Andrés Ponce4Beatriz Frade-sosa5Ana Milena Millán Arciniegas6Fabiola Ojeda7Virginia Ruiz-Esquide8Hector Corominas9Rheumatology Department, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, SpainDepartment of Medicine, Universitat de Barcelona, Barcelona, SpainRheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainRheumatology Department, Hospital del Mar, Barcelona, SpainRheumatology Department, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, SpainRheumatology Department, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, SpainRheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainRheumatology Department, Hospital del Mar, Barcelona, SpainRheumatology Department, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, SpainRheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainObjectivesTo describe different clinical patterns of rheumatic immune-related adverse events (irAEs) induced by immune checkpoint inhibitors (ICI) and their rheumatic and oncologic outcomes.MethodsWe classified clinical syndromes according to five different categories: non-inflammatory arthralgias (NIA), rheumatoid arthritis (RA)-like, psoriatic arthritis (PsA)-like, polymyalgia rheumatica (PMR)-like, and a miscellaneous group of patients with other syndromes. We conducted a baseline visit and then follow-up in order to determine their clinical pattern, treatment response, and outcome.ResultsWe included 73 patients (64% male) with a mean age of 66.1 ± 11.6 years. Main underlying diagnosis was lung carcinoma in 29 (39%) patients, melanoma in 20 (27%), and renal-urothelial cancer in 11 (15%). Main ICI included Pembrolizumab in 24 (32%), Nivolumab 17 (23%), and Atezolizumab 7 (9 %). Seventeen out of seventy-three patients had an underlying rheumatic disease before ICI treatment. Fourteen patients developed other irAEs before or simultaneously with rheumatic syndromes. Main rheumatic irAEs included: RA-like in 31 (42.4%), NIA in 19 (26.0%), PMR-like in 10 (13.7%), and PsA-like in 5 (6.8%), among others. Median time from ICI to irAEs was 5 months (IQR 3–9). Those patients who received combined therapy, had a trend for an earlier presentation than those who received monotherapy (4.3 months IQR 1.85–17 vs. 6 months IQR 3–9.25, p = NS). Mean follow-up time was 14.0 ± 10.8 (SD, months). At the last visit, 47 % were taking glucocorticoids and 11% DMARD therapy. At the last visit, 13 (17.8%) patients remained with persistent arthritis, 19 (26%) had intermittent flares, and 39 (53.4%) had a self-limited pattern. Only in 15.1% of patients ICI therapy was discontinued.ConclusionsWe described different patterns according to treatment and irAEs. Combined ICI therapy had an earlier onset of symptoms. Patients who presented as RA-like, had a higher risk of persistent arthritis. After a mean follow-up of more than 1 year, one-fifth of the patients remained with persistent arthritis and 11% required DMARD therapy.https://www.frontiersin.org/articles/10.3389/fmed.2022.888377/fullimmunotherapyadverse (side) effectscheckpointarthritispolymyalgia rheumatica |
| spellingShingle | José A. Gómez-Puerta José A. Gómez-Puerta David Lobo-Prat Carolina Perez-García Andrés Ponce Beatriz Frade-sosa Ana Milena Millán Arciniegas Fabiola Ojeda Virginia Ruiz-Esquide Hector Corominas Clinical Patterns and Follow-Up of Inflammatory Arthritis and Other Immune-Related Adverse Events Induced by Checkpoint Inhibitors. A Multicenter Study Frontiers in Medicine immunotherapy adverse (side) effects checkpoint arthritis polymyalgia rheumatica |
| title | Clinical Patterns and Follow-Up of Inflammatory Arthritis and Other Immune-Related Adverse Events Induced by Checkpoint Inhibitors. A Multicenter Study |
| title_full | Clinical Patterns and Follow-Up of Inflammatory Arthritis and Other Immune-Related Adverse Events Induced by Checkpoint Inhibitors. A Multicenter Study |
| title_fullStr | Clinical Patterns and Follow-Up of Inflammatory Arthritis and Other Immune-Related Adverse Events Induced by Checkpoint Inhibitors. A Multicenter Study |
| title_full_unstemmed | Clinical Patterns and Follow-Up of Inflammatory Arthritis and Other Immune-Related Adverse Events Induced by Checkpoint Inhibitors. A Multicenter Study |
| title_short | Clinical Patterns and Follow-Up of Inflammatory Arthritis and Other Immune-Related Adverse Events Induced by Checkpoint Inhibitors. A Multicenter Study |
| title_sort | clinical patterns and follow up of inflammatory arthritis and other immune related adverse events induced by checkpoint inhibitors a multicenter study |
| topic | immunotherapy adverse (side) effects checkpoint arthritis polymyalgia rheumatica |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.888377/full |
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