Immune checkpoint inhibitor associated vasculitis and polymyalgia rheumatica: a case series and systematic review
Bibliographic record
Abstract
BACKGROUND: Immune checkpoint inhibitors (ICIs) have been associated with immune-related adverse events (irAEs), including ICI associated vasculitis (ICI-vasculitis) and ICI associated PMR (ICI-polymyalgia rheumatica (PMR)-like syndromes). We sought to describe the characteristics of ICI-vasculitis and ICI-PMR in individuals treated with ICIs through a systematic review and local case series. METHODS: We searched MEDLINE and Embase from inception to July 2023 for cases of ICI-vasculitis and ICI-PMR in ICI-treated individuals. Our series included cases obtained from clinicians at the Universities of Toronto, McMaster, and Western in Ontario, Canada. RESULTS: One hundred and forty-four patients were identified: 130 from the systematic review in 76 articles and 14 from our case series. This included 73 patients with ICI-vasculitis (14 large vessel, 7 ANCA-associated, 52 other) and 71 with ICI-PMR. Ninety-five per cent of patients were treated with glucocorticoids and 17% received disease-modifying antirheumatic drugs (DMARDs). Among 4 individuals with vasculitis who continued the ICI, two remitted. Of five who paused and restarted ICIs, one experienced a recurrence. Among four individuals with vasculitis who continued ICIs, two remitted. All 11 ICI-PMR cases that continued ICIs remitted; among 3 patients who paused and restarted two did not relapse and one had a relapse that improved with an increase in their dose of prednisone. CONCLUSION: ICI-vasculitis and ICI-PMR are underrecognized complications of ICIs. Glucocorticoids are effective for ICI-vasculitis and ICI-PMR. It is unclear if ICIs can be safely continued or restarted after remission of ICI-vasculitis or ICI-PMR. Limited data suggests ICIs may be resumed in individuals with non-severe ICI-vasculitis or ICI-PMR.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".