Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation
Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation
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DOI：
10.1136/annrheumdis-2019-216109
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发表时间：
2020-03-01
影响因子：
27.4
通讯作者：
Cappelli, Laura C.
中科院分区：
文献类型：
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作者：
Braaten, Tawnie J.;Brahmer, Julie R.;Cappelli, Laura C.
目的研究免疫检查点抑制剂(ICI)诱导的炎性关节炎(IA)患者的长期预后，明确ICI停止后IA持续存在的相关因素、免疫抑制剂的需求以及这些药物对潜在恶性肿瘤的影响。患者招募时间为2015年6月至2018年12月。在基线访问时获得信息，并在ICI停止后不同的时间间隔进行跟踪访问长达24个月。Kaplan-Meier曲线被用来描述IA的持续性。用COX比例风险模型评估各种因素对IA持续性的影响。采用Logistic回归分析评价IA治疗对肿瘤疗效的影响。结果60例患者在ICI停止治疗9个月后获得中位随访期。大多数(53.3%)在他们最近的随访中有活跃的IA。在ICI使用时间较长的患者、接受联合ICI治疗的患者以及有多种其他免疫相关不良事件的患者中，IA改善的可能性较小。肿瘤反应似乎不受免疫抑制的影响。虽然无统计学意义，但持续性IA与较好的肿瘤反应(完全或部分反应)相关。结论ICI诱导的IA可成为一种需要风湿科进行免疫调节治疗的长期疾病。重要的是，在这项研究中，免疫调节治疗的使用并未显示出对癌症预后的影响。
Objective We sought to investigate the long-term outcomes of patients who develop immune checkpoint inhibitor (ICI)-induced inflammatory arthritis (IA), to define factors associated with IA persistence after ICI cessation, the need for immunosuppressants and the impact of these medications on underlying malignancies.Methods We conducted a prospective observational study of patients referred for IA associated with ICIs. Patients were recruited from June 2015 to December 2018. Information was obtained at the baseline visit, and follow-up visits occurred at varying intervals for up to 24 months from ICI cessation. Kaplan-Meier curves were developed to characterise IA persistence. Cox proportional hazards models were used to assess the influence of various factors on IA persistence. Logistic regression was used to evaluate the impact of IA treatment on tumour response.Results Sixty patients were monitored with a median follow-up after ICI cessation of 9 months. A majority (53.3%) had active IA at their most recent follow-up. IA was less likely to improve in those with longer duration of ICI use, in those receiving combination ICI therapy, and in patients with multiple other immune-related adverse events. Tumour response did not appear to be impacted by immunosuppression. Although not statistically significant, persistent IA was correlated with a better tumour response (complete or partial response).Conclusion ICI-induced IA can become a long-term disease necessitating management by rheumatology for immunomodulatory treatment. Importantly, the use of immunomodulatory treatment has not been shown to impact cancer outcomes in this study.