Cancer Immunotherapy May Raise Rheumatoid Arthritis Risk

TOPLINE:

According to a study of over five million patients with a neoplasm, those who received an immune checkpoint inhibitor (ICI) faced a 26% higher risk for rheumatoid arthritis (RA) than those receiving other types of cancer therapy.

METHODOLOGY:

• Researchers conducted this retrospective observational study using data from the global federated research network TriNetX to evaluate the prevalence of new-onset autoimmune conditions following the initiation of ICIs in patients with a neoplasm.
• A total of 5,259,415 patients diagnosed with a neoplasm were identified, of whom 106,809 (2.03%) received ICIs.
• Participants were divided into two groups: Those who received ICIs and those who did not. ICIs included atezolizumab, avelumab, durvalumab, dostarlimab, cemiplimab, nivolumab, pembrolizumab, ipilimumab, and tremelimumab.
• The prevalence of various autoimmune conditions, such as vasculitis, systemic lupus erythematosus, dermatopolymyositis, systemic sclerosis, RA, and psoriatic arthritis, was assessed.

TAKEAWAY:

• Patients who received ICIs were younger than those who did not (mean age, 68.7 vs 71.8 years) and were predominantly men (54% vs 41%) and White individuals (68% vs 58%).
• The prevalence of RA was significantly higher in the ICI group than in the non-ICI group (2.19% vs 1.75%; odds ratio [OR], 1.258; P
• Patients who received a combination treatment with both cytotoxic T-lymphocyte-associated protein 4 inhibitor and programmed cell death protein 1 (PD1) inhibitor/PD ligand 1 (PDL1) inhibitors showed a higher prevalence of vasculitis (P = .0355) and RA (P
• However, patients who received vs did not receive ICIs showed lower odds of developing systemic lupus erythematosus (OR, 0.837; P = .0005) and systemic sclerosis (OR, 0.796; P = .0151); no significant differences were observed in the prevalence of vasculitis, dermatomyositis, and psoriatic arthritis between the groups.

IN PRACTICE: 

“It is imperative to monitor for symptoms and signs of inflammatory arthritis, especially RA, in patients receiving ICIs, particularly in the CT [combination treatment] group,” the authors wrote.

SOURCE:

This study was led by Pushti Khandwala, MBBS, Jefferson Einstein Philadelphia Hospital, Philadelphia, and was published online on January 24, 2025, in ACR Open Rheumatology.

LIMITATIONS:

This study relied on TriNetX’s Global Collaborative Database, which may have limitations related to coding accuracy and data entry. Being retrospective in nature, the study could only report associations between ICI use and the prevalence of autoimmune conditions without proving causation. Moreover, there may have been delays in diagnosis or missed cases of autoimmune conditions as patients were not consistently followed by rheumatologists.

DISCLOSURES:

This study did not report any source of funding. The authors had no relevant disclosures.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.