Patients With RA May Safely Receive ICIs for Cancer Treatment

Patients with and without RA initiating treatment with immune checkpoint inhibitors had similar risk for mortality and severe immune-related adverse events.

Rheumatoid arthritis (RA) may not be a significant risk factor for adverse events (AEs) during initiation of immune checkpoint inhibitors (ICIs) for cancer treatment, according to research results published in BMC Rheumatology.

Researchers aimed to evaluate whether preexisting RA was associated with a higher mortality and risk for immune-related AEs with ICI use for cancer treatment.

Researchers conducted a retrospective comparative cohort study to identify individuals who initiated treatment with ICIs from April 2011 to 2021. 

Patients with RA were identified for the study using International Classification of Diseases, Ninth Revision (ICD-9) codes, and were age-, sex-, and cancer stage-matched with up to 3 comparators.  The ICIs included the study included PD-1 (pembrolizumab, nivolumab, and cemiplimab), PD-L1 (atezolizumab, avelumab, and durvalumab) and CTLA-4 (ipilimumab and tremelimumab) inhibitors.

Coprimary outcomes included time from initiation to death and time from initiation to first immune-related AE. Secondary outcomes included number and types of immune-related AEs.

These results suggest that this patient population can safely receive immune checkpoint inhibitors for cancer treatment.

A total of 87 patients with RA were matched with 203 non-RA comparators. The PD-1 inhibitors were the most commonly used immune-checkpoint inhibitors, accounting for 92% of patients with RA and 93% of the comparators. Lung cancer was the most common type of cancer, accounting for 49% among patients with RA and 56% among comparators.

A total of 69% of patients with RA compared with 63% of comparators died (P =.30). Overall, 61% of patients with RA compared with 49% of comparators had any all grade immune-related AEs (P =.058). When comparing specific types of immune-related AEs, RA flares occurred in 48% of those with RA compared with 7% of comparators (P <.0001).  Patients with RA vs comparators were less likely to experience any rash or dermatitis, endocrinopathy, colitis or enteritis, and hepatitis.

Researchers did not observe a statistical difference for cumulative incidence of mortality between the RA and comparator groups. Excluding RA flares or any inflammatory arthritis-related AEs, those with RA vs comparators had a lower cumulative incidence of other types of all grade immune-related AEs.

One of the study limitations included the lack of generalizability to patients with RA receiving other treatments for cancer.

The study authors concluded, “Although patients with pre-existing [RA] were more likely to have immune-related AEs, this finding was mostly due to mild rheumatoid arthritis flares.” They added, “These results suggest that this patient population can safely receive immune checkpoint inhibitors for cancer treatment.”


Lusa A, Alvarez C, Saxena Beem S, Schwartz TA, Ishizawar R. Immune-related adverse events in patients with pre-existing autoimmune rheumatologic disease on immune checkpoint inhibitor therapyBMC Rheumatol. 2022;6(1):64. Published November 8, 2022. doi:10.1186/s41927-022-00297-5