Immune checkpoint inhibitors, which are used to treat many types of cancer, can cause syndromes similar to rheumatic diseases known as immune-related adverse events (irAEs). In 2020, several studies illustrated the clinical heterogeneity of rheumatic irAEs and highlighted their substantial effect on morbidity and mortality.
Key advances
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Immune checkpoint inhibitor (ICI)-induced myositis has a high mortality rate, particularly when associated with myocarditis and myasthenia gravis, and can happen shortly after ICI initiation2.
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Rheumatic immune-related adverse events (irAEs) of all kinds necessitate systemic immunosuppression, and for most patients in one multicentre study, tumour response did not worsen after treatment of these irAEs3.
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Patients with inflammatory arthritis attributable to ICI therapy experience substantial emotional and functional effects, outcomes that could be improved with increased awareness, multidisciplinary care and increased social support4.
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References
Kostine, M., Truchetet, M. E. & Schaeverbeke, T. Clinical characteristics of rheumatic syndromes associated with checkpoint inhibitors therapy. Rheumatology 58 (Suppl. 7), vii68–vii74 (2019).
Allenbach, Y. et al. Immune checkpoint inhibitor-induced myositis, the earliest and most lethal complication among rheumatic and musculoskeletal toxicities. Autoimmun. Rev. 19, 102586 (2020).
Roberts, J. et al. Rheumatic immune-related adverse events associated with cancer immunotherapy: a nationwide multi-center cohort. Autoimmun. Rev. 19, 102595 (2020).
Cappelli, L. C., Grieb, S. M., Shah, A. A., Bingham, C. O. 3rd & Orbai, A. M. Immune checkpoint inhibitor-induced inflammatory arthritis: a qualitative study identifying unmet patient needs and care gaps. BMC Rheumatol. 4, 32 (2020).
Calabrese, L. H., Calabrese, C. & Cappelli, L. C. Rheumatic immune-related adverse events from cancer immunotherapy. Nat. Rev. Rheumatol. 14, 569–579 (2018).
Subedi, A. et al. Use of magnetic resonance imaging to identify immune checkpoint inhibitor-induced inflammatory arthritis. JAMA Netw. Open 3, e200032 (2020).
Albayda, J., Dein, E., Shah, A. A., Bingham, C. O. 3rd & Cappelli, L. Sonographic findings in inflammatory arthritis secondary to immune checkpoint inhibition: a case series. ACR Open Rheum. 1, 303–307 (2019).
Daoussis, D. et al. An MRI study of immune checkpoint inhibitor-induced musculoskeletal manifestations myofasciitis is the prominent imaging finding. Rheumatology 59, 1041–1050 (2020).
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L.C.C. and C.O.B. declare that they have received research funding from Bristol-Myers Squibb, and that L.C.C. has acted as a consultant for AbbVie.
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Cappelli, L.C., Bingham, C.O. Spectrum and impact of checkpoint inhibitor-induced irAEs. Nat Rev Rheumatol 17, 69–70 (2021). https://doi.org/10.1038/s41584-020-00546-2
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DOI: https://doi.org/10.1038/s41584-020-00546-2
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