Immune Checkpoint Inhibitors in Patients with Pre-Existing Rheumatic Disease and the Impact of Immunosuppression: Data from the Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO)

Objectives Immune checkpoint inhibitors (ICI) have transformed oncology care, but their use is limited by immune-related adverse events (irAEs) and optimal use in patients with rheumatic pre-existing autoimmune disease (Rh-PAD) is unknown.[1] We report on ICI management, baseline immunosuppression, and irAE treatment strategies, using data from the CanRIO retrospective and prospective cohorts from 10 Canadian sites. Methods Patients with Rh-PAD recruited to the prospective cohort between Jan 2020 and April 2023 and retrospective cohort from Jan 2013 to June 2022 and who received at least 1 dose of CTLA-4, PD-1, or PDL-1 ICI therapy were included. Data on irAE treatment, baseline immunosuppression, and cancer outcomes are collected in a REDCap database as per standardized protocol. Results Eighty-three eligible patients (40 from prospective and 43 from retrospective cohort) were identified and stratified by baseline immunosuppression (IS), with 44 on baseline IS and 39 not on baseline IS. Baseline IS included corticosteroids, conventional DMARDs, and biologic DMARDs. Of those on baseline IS, 37 had inflammatory arthritis (48.65% active) and 7 had other rheumatic disease (57.14% active). Of those not on baseline IS, 26 had inflammatory arthritis (26.92% active) and 13 had other rheumatic disease (23.08% active). Patients on baseline IS were more likely to have a PAD flare (OR 4.19, P=0.003) and less likely to develop a new unrelated irAE (OR 0.36, P=0.027) compared to those not on baseline IS. In both cohorts, 4 patients experienced both a flare of their Rh-PAD and a de novo irAE. Those with de novo irAE generally responded to analgesics, corticosteroids or csDMARDs. There was a non-significant trend toward patients on baseline IS being more likely to require bDMARD compared to those not on baseline IS (P = 0.057). Grade 1-2 irAEs were more likely to be treated while continuing immunotherapy, while ICIs were either stopped or held in all patients with grade 3-5 events (Baseline IS P = 0.026; No Baseline IS P = 0.052; All Patients P < 0.001). Conclusion Our findings suggest those on baseline IS have higher rates of active PAD at start of ICI therapy. We found 1) Continuing baseline DMARDs may not protect from flares but may prevent de novo irAEs. If de-novo irAEs occur, bDMARD may be required for treatment 2) Continuing immunotherapy during irAE treatment can be considered for patients with low grade irAEs. Future analyses will explore the impact of baseline IS on cancer outcomes. [1.] Khalil DN. Nat Rev Clin 2016;13:273-90.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.