TOPLINE:
A comprehensive study involving over five million cancer patients reveals that those treated with immune checkpoint inhibitors (ICIs) have a 26% greater likelihood of developing rheumatoid arthritis (RA) compared to those undergoing other forms of cancer therapy.
METHODOLOGY:
- Researchers utilized data from the TriNetX global federated research network to conduct a retrospective observational study.
- The study analyzed 5,259,415 patients with cancer, identifying 106,809 (2.03%) who received ICIs.
- Participants were categorized into two groups: those who received ICIs and those who did not.
- ICIs studied included atezolizumab, avelumab, durvalumab, dostarlimab, cemiplimab, nivolumab, pembrolizumab, ipilimumab, and tremelimumab.
- The prevalence of various autoimmune conditions, such as vasculitis, systemic lupus erythematosus (SLE), dermatopolymyositis (DM), systemic sclerosis (SSc), RA, and psoriatic arthritis (PsA), was evaluated.
FINDINGS:
The study uncovered demographic differences between the groups. Patients receiving ICIs were younger on average (68.7 vs 71.8 years) and more likely to be male (54% vs 41%) and White (68% vs 58%).
The prevalence of RA was notably higher in patients who received ICIs (2.19%) compared to those who did not (1.75%). The odds ratio (OR) was 1.258, indicating a significant association.
Interestingly, patients who underwent combination treatment with both a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitor and a programmed cell death protein 1 (PD-1) inhibitor or programmed cell death ligand 1 (PD-L1) inhibitor showed an increased risk of developing vasculitis (P = .0355) and RA.
Conversely, ICIs were associated with a lower likelihood of developing SLE (OR, 0.837; P = .0005) and SSc (OR, 0.796; P = .0151). However, no significant differences were observed in the occurrence of vasculitis, DM, or PsA between the groups treated with ICIs and those who were not.
IN PRACTICE:
Healthcare providers are advised to be vigilant in monitoring patients on ICIs, particularly those receiving combination treatments, for signs and symptoms of inflammatory arthritis, with a focus on RA.
LIMITATIONS:
While the study provides valuable insights, it lacked details on specific funding sources and did not account for all possible variables that might influence the risk of developing autoimmune conditions.
DISCLOSURES:
The study did not disclose any funding or conflicts of interest from the authors.
In Summary: The research highlights a critical issue in the field of cancer immunotherapy, suggesting that while ICIs offer potent benefits in fighting cancer, they also pose risks of triggering autoimmune conditions like RA. This information underscores the importance of careful patient monitoring and the need for further research to mitigate these risks.
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