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Rheumatoid arthritis and polymyalgia rheumatica occurring after immune checkpoint inhibitor treatment.

Abstract：

OBJECTIVES:Immune checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte-associated protein 4 and programmed cell death protein 1 (PD-1) have demonstrated improved survival for multiple cancers. However, these new drug classes have led to increased immune-related adverse events (IrAE). Rheumatic IrAEs have not been well described in clinical trials. We report here cases of rheumatoid arthritis (RA) and polymyalgia rheumatica (PMR) occurring after ICI treatment. METHODS:This was a retrospective study of patients receiving an ICI in whom symptoms of arthritis or arthralgia developed and revealed a diagnosis of RA or PMR. RESULTS:In 10 patients who received ICI therapy (all anti-PD-1 or anti-PDL1 antibodies), RA or PMR developed at a median of 1 month (1 to 9) after exposure. No patient had pre-existing rheumatic or autoimmune disease. RA developed in six patients; all six were positive for anti-cyclic citrullinated peptide (anti-CCP) antibodies and four for rheumatoid factor. Anti-CCP antibodies were detected in two out of three patients tested before immunotherapy. Disease-modifying antirheumatic drugs were needed for three patients; the three others received corticosteroids or non-steroid anti-inflammatory drugs. PMR was diagnosed in four patients, all responded to corticosteroids. Despite these IrAEs, immunotherapy was pursued for all but one patient until cancer progression. CONCLUSIONS:This is the first description of RA occurring after ICI therapy for cancer. PMR can also occur after ICI, particularly after anti-PD-1 therapy. All cases responded to corticosteroids or with immunosuppressive therapy. Collaboration between rheumatologists and oncologists is crucial and could lead to better recognition and care of these patients.

journal_name

Ann Rheum Dis

journal_title

Annals of the rheumatic diseases

authors

Belkhir R,Burel SL,Dunogeant L,Marabelle A,Hollebecque A,Besse B,Leary A,Voisin AL,Pontoizeau C,Coutte L,Pertuiset E,Mouterde G,Fain O,Lambotte O,Mariette X

doi

10.1136/annrheumdis-2017-211216

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

1747-1750

issue

eissn

0003-4967

issn

1468-2060

pii

annrheumdis-2017-211216

journal_volume

pub_type

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Rheumatoid arthritis and polymyalgia rheumatica occurring after immune checkpoint inhibitor treatment.