Best Treatments for Immune Checkpoint Inhibitor-associated Arthritis Save
A retrospective study of cancer patients who developed immune checkpoint inhibitor-associated inflammatory arthritis (ICI-IA) shows that biologic DMARDs were more effective than conventional synthetic DMARDs (csDMARDs) in rapid control of arthritis.
The study included ICI-IA patients treated with either a tumour necrosis factor inhibitor (TNFi), interleukin-6 receptor inhibitor (IL6Ri) and/or methotrexate (MTX). Patients with pre-existing autoimmune disease were excluded. The primary outcome was time to cancer progression from ICI initiation; the secondary outcome was time to arthritis control from DMARD initiation.
A total of 147 patients (mean age 60.3 years, 45% women) were included. Treatments included TNFi (22%), IL6Ri (29%) and MTX (49%). Overall, the time to cancer progression was significantly shorter for TNFi compared with MTX (HR 3.27; 1.21 to 8.84, p=0.019) and almost significant for those on IL6Ri (HR 2.37; 0.94 to 5.98, p=0.055).
Time to arthritis control was faster for TNFi compared with MTX (HR 1.91;1.06 to 3.45, p=0.032) while IL6Ri therapy tended to be almost as rapid (HR 1.66;0.93 to 2.97, p=0.089).
These findings suggest that patients with ICI-IA appear to benefit from TNFi, moreso than IL-6i, with both yielding more rapid arthritis control than with MTX. The downside is that use of these biologics may be associated with a shorter time to cancer progression.
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