Resolution of immune checkpoint inhibitors-induced inflammatory arthritis while maintaining active treatment with checkpoint inhibitors and after its discontinuation: An observational study

Alexandra Ladouceur; Thomas Barnetche; Sorilla Prey; Caroline Dutriaux; Émilie Gerard; Anne Pham-Ledard; Marie Beylot-Barry; Maeva Zysman; Rémi Veillon; Charlotte Domblides; Amaury Daste; Marine Gross-Goupil; Baptiste Sionneau; Felix Lefort; Larroquette Mathieu; Christophe Richez; Marie-Elise Truchetet; Thierry Schaeverbeke; Marie Kostine

doi:10.1016/j.jbspin.2024.105795

Resolution of immune checkpoint inhibitors-induced inflammatory arthritis while maintaining active treatment with checkpoint inhibitors and after its discontinuation: An observational study

Joint Bone Spine. 2024 Oct 22;92(1):105795. doi: 10.1016/j.jbspin.2024.105795. Online ahead of print.

Authors

Alexandra Ladouceur¹, Thomas Barnetche², Sorilla Prey³, Caroline Dutriaux³, Émilie Gerard³, Anne Pham-Ledard⁴, Marie Beylot-Barry³, Maeva Zysman⁵, Rémi Veillon⁵, Charlotte Domblides⁶, Amaury Daste⁶, Marine Gross-Goupil⁶, Baptiste Sionneau⁶, Felix Lefort⁶, Larroquette Mathieu⁶, Christophe Richez², Marie-Elise Truchetet², Thierry Schaeverbeke², Marie Kostine²

Affiliations

¹ Department of Rheumatology, Hôpital Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France; Department of Medicine, McGill University, 845, rue Sherbrooke Ouest, Montréal, QC H3A 0G4, Canada. Electronic address: Alexandra.ladouceur@mail.mcgill.ca.
² Department of Rheumatology, Hôpital Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France.
³ Department of Dermatology, Hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France.
⁴ Department of Dermatology, Hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France; Bordeaux Institute of Oncology, BRIC U1312 Team 5, Inserm, 2, rue du Dr-Hoffmann-Martinot, 33000 Bordeaux, France.
⁵ Department of Pulmonology, Hôpital Haut-Lévêque, avenue Magellan, 33600 Pessac, France.
⁶ Department of Medical Oncology, Hôpital Saint-André, 1, rue Jean-Burguet, 33000 Bordeaux, France.

PMID: 39447690
DOI: 10.1016/j.jbspin.2024.105795

Abstract

Introduction: Immune checkpoint inhibitors-induced inflammatory arthritis (ICI-IA) affects about 5% of ICI recipients. We aimed (1) to characterize the resolution of ICI-IA during ICI treatment and after ICI discontinuation and (2) to assess how ICI-IA influences ICI management across time.

Methods: All ICI-treated patients referred to rheumatology at Bordeaux University Hospital were identified and patients with ICI-IA with a follow-up of≥6months after ICI-IA onset were included. Resolution of ICI-IA was defined by discontinuation of ICI-IA medications without recurrence of ICI-IA symptoms.

Results: Resolution of ICI-IA occurred in 13 of 80 patients (16%) while maintaining active ICI treatment, mainly in patients with polymyalgia rheumatica (PMR)-like clinical presentation (P=0.03). Synovitis was more frequent in those whose ICI-IA persisted throughout ICI treatment. In patients with persistent ICI-IA throughout ICI treatment, 34 (50%) and 47 (70%) resolved at 6- and 12-months post-ICI discontinuation, respectively. Reason for terminating ICI was more frequently cancer stable or in remission in those who still had active ICI-IA at 6- and 12-months post-ICI discontinuation. Both progression-free survival and overall survival were longer in the groups with active ICI-IA at 6- and 12-months after ICI discontinuation.

Discussion: In this cohort, ICI was safely continued in most patients experiencing ICI-IA. About one sixth of ICI-IA resolved despite maintaining active ICI treatment and allowing ICI-IA treatment discontinuation without recurrence of symptoms, mainly in those with PMR-like presentation. Larger studies are needed to determine predicting factors of resolving ICI-IA to minimize exposure to immunosuppressive treatment.

Keywords: Arthritis; Immune checkpoint inhibitors; Immune-related adverse events; Tumour outcomes.