Article
Characteristics and treatment of new onset arthritis after checkpoint inhibitor therapy
Search Medline for
Authors
Published: | September 4, 2017 |
---|
Outline
Text
Background: The recent introduction of biologic agents targeting immunologic checkpoints (immune checkpoint inhibitors, ICIs) established immunotherapy as a highly effective cancer therapy. ICI that trigger an anti-tumor response by activation of T cells, may also cause immune-related adverse events (IRAEs). Characterization of musculoskeletal (ms) IRAEs such as arthritis and data on treatment of msIRAEs are scarce.
Methods: In this prospective observational study, patients receiving ICI therapy who experienced arthralgia were evaluated for the presence of msIRAEs. Data on demographics, ICI regime, time of onset and response to therapy of msIRAEs, imaging and laboratory analysis were prospectively collected.
Results: A total of nine patients with arthralgias after initiation of ICI therapy were assessed. Arthritis was demonstrated in eight patients of whom 3 showed monoarthritis, 3 oligoarthritis and 2 polyarthritis. PMR-like disease with typical ultrasound findings was evident in one case. One patient was seropositive and developed highly active RA immediately after first infusion of nivolumab. Regarding the detection of msIRAEs on imaging, good sensitivity for PET-CT as opposed to contrast-enhanced CT was observed. Disease burden at baseline was high and was significantly reduced after anti-inflammatory treatment. Six patients were treated with systemic and 6 patients with intraarticular glucocorticoids (GC). Five patients flared on sole GC treatment upon tapering and were given methotrexate. Patients were followed for a median of 224 days, and no safety signal was detected.
Conclusion: While local GC injection appeared sufficient for monarthritis, in oligo- or polyarthritis tapering of systemic GC was frequently associated with flares and required DMARD therapy with methotrexate that proved to be efficacious. This is the first report on prospective follow-up of ICI-induced arthritis and provides preliminary data on efficacy and safety of methotrexate as a GC-sparing agent.