The following is a summary of “Immunomodulator use, risk factors and management of flares, and mortality for patients with pre-existing rheumatoid arthritis after immune checkpoint inhibitors for cancer,” published in the December 2023 issue of Rheumatology by McCarter et al.

The objective of this retrospective cohort study was to analyze immunomodulator use, risk factors, and management of rheumatoid arthritis (RA) flares, along with mortality rates in patients with pre-existing RA who initiated immune checkpoint inhibitors (ICI) for cancer treatment. A total of 100 pre-existing RA patients (mean age 70.3 years, 63% female, predominantly PD-1 monotherapy for lung cancer) were studied from a pool of 11,901 patients who underwent ICI treatment for cancer at Mass General Brigham or Dana-Farber Cancer Institute between 2011 and 2022. 

Results indicated that at ICI initiation, most patients had seropositive RA with remission/low disease activity—only a small percentage discontinued or changed their RA medications before starting ICI. RA flares were observed in almost half of the patients, with the majority being mild and treated with typical therapies. While seropositivity was linked to increased risk for RA flare, other baseline factors, including cancer type, RA disease activity, and duration, were not associated. Although a minority experienced severe RA flares necessitating ICI interruption, these flares were not correlated with increased mortality. Overall, these findings highlight the occurrence of RA flares following ICI initiation among patients with pre-existing RA, with seropositivity serving as a risk factor but without a significant association between RA flares and increased mortality.

Source: sciencedirect.com/science/article/abs/pii/S0049017223001774