Immune Checkpoint Inhibitor-Induced Arthritis: Incidence and Treatment Efficacy

MADRID — In immune checkpoint inhibitor-induced arthritis, some patients may be effectively treated with glucocorticoids, indicating the important role of rheumatologists, according to a study presented at the 2019 European League Against Rheumatism (EULAR) Congress, held June 12-15, in Madrid, Spain.

To determine the frequency of musculoskeletal manifestations, the most common class of immune-related adverse event in patients treated with immune checkpoint inhibitors, researchers organized a combined outpatient clinic for rheumatology/oncology patients. Baseline demographic data, diagnosis date, comorbidities, and concomitant medications were collected and entered into a standardized electronic form.

Patients underwent physical and laboratory evaluations to assess the presence of tender and swollen joints; if joint involvement was present, researchers measured disease activity score and used ultrasound to assess for the presence of active synovitis. Laboratory evaluations assessed C-reactive protein, erythrocyte sedimentation rate, and autoantibodies.

In total, 72 individuals were evaluated (median age 66 years, interquartile range [IQR] 13; median disease duration 7 months, IQR 13). In terms of malignant diseases, 75.1% of patients had non-small cell lung cancer, 15.3% had renal cell carcinoma, 6.9% had melanoma, and 2.7% had another malignancy. All patients were treated with anti-PD-1; 93.1% were treated with nivolumab, and 6.9% were treated with pembrolizumab.

During treatment with these immune checkpoint inhibitors, 9.7% of patients developed clinically evident synovitis, with clinical manifestations including symmetric polyarthritis, monoarthritis, polyarthritis, and oligoarthritis. Six of these patients were treated with prednisone (dose range 10-12.5 mg/daily) or nonsteroidal anti-inflammatory drugs.

One patient was treated with methotrexate (10 mg weekly). All patients achieved rapid, complete, and persistent response, and the patient undergoing methotrexate treatment achieved remission after 6 weeks.

The researchers of the study noted that this is the first attempt to apply a multidisciplinary rheumatology/oncology approach to evaluate and treat this patient population. Although the absolute risk for synovitis development was high (10%), the majority of patients “promptly respond[ed] to glucocorticoids and [did] not require further [disease-modifying antirheumatic drug] treatment,” the researchers concluded.

Disclosure: Dr Carlo Perricone reports relationships with BMS, Lilly, Celgene, and Sanofi.

Reference

Ceccarelli F, Botticelli A, Gelibter A, et al. Inflammatory arthritis induced by immune-checkpoint inhibitors: results from a combined rheumatology/oncology outpatient clinic. Presented at: European League Against Rheumatism (EULAR) Congress 2019; June 12-15, 2019; Madrid, Spain. Abstract FRI0035.