Lee Charlotte, Drobni Zsofia D, Zafar Amna, Gongora Carlos A, Zlotoff Daniel A, Alvi Raza M, Taron Jana, Rambarat Paula K, Schoenfeld Sara, Mosarla Ramya C, Raghu Vineet K, Hartmann Sarah E, Gilman Hannah K, Murphy Sean P, Sullivan Ryan J, Faje Alexander, Hoffmann Udo, Zhang Lili, Mayrhofer Thomas, Reynolds Kerry L, Neilan Tomas G
Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA.
Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
JACC CardioOncol. 2022 Dec 20;4(5):660-669. doi: 10.1016/j.jaccao.2022.11.008. eCollection 2022 Dec.
The use of immune checkpoint inhibitors (ICI) is associated with cardiovascular (CV) events, and patients with pre-existing autoimmune disease are at increased CV risk.
The aim of this study was to characterize the risk for CV events in patients with pre-existing autoimmune disease post-ICI.
This was a retrospective study of 6,683 patients treated with ICIs within an academic network. Autoimmune disease prior to ICI was confirmed by chart review. Baseline characteristics and risk for CV and non-CV immune-related adverse events were compared with a matched control group (1:1 ratio) of ICI patients without autoimmune disease. Matching was based on age, sex, history of coronary artery disease, history of heart failure, and diabetes mellitus. CV events were a composite of myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, stroke, transient ischemic attack, deep venous thrombosis, pulmonary embolism, or myocarditis. Univariable and multivariable Cox proportional hazards models were used to determine the association between autoimmune disease and CV events.
Among 502 patients treated with ICIs, 251 patients with and 251 patients without autoimmune disease were studied. During a median follow-up period of 205 days, there were 45 CV events among patients with autoimmune disease and 22 CV events among control subjects (adjusted HR: 1.77; 95% CI: 1.04-3.03; = 0.0364). Of the non-CV immune-related adverse events, there were increased rates of psoriasis (11.2% vs 0.4%; < 0.001) and colitis (24.3% vs 16.7%; = 0.045) in patients with autoimmune disease.
Patients with autoimmune disease have an increased risk for CV and non-CV events post-ICI.
免疫检查点抑制剂（ICI）的使用与心血管（CV）事件相关，已有自身免疫性疾病的患者发生心血管事件的风险增加。
本研究旨在描述已有自身免疫性疾病的患者在接受ICI治疗后发生心血管事件的风险特征。
这是一项对学术网络中6683例接受ICI治疗患者的回顾性研究。通过病历审查确认ICI治疗前的自身免疫性疾病。将基线特征以及心血管和非心血管免疫相关不良事件的风险与无自身免疫性疾病的ICI患者匹配对照组（1:1比例）进行比较。匹配基于年龄、性别、冠状动脉疾病史、心力衰竭史和糖尿病史。心血管事件包括心肌梗死、经皮冠状动脉介入治疗、冠状动脉搭桥术、中风、短暂性脑缺血发作、深静脉血栓形成、肺栓塞或心肌炎。采用单变量和多变量Cox比例风险模型来确定自身免疫性疾病与心血管事件之间的关联。
在502例接受ICI治疗的患者中，研究了251例有自身免疫性疾病的患者和251例无自身免疫性疾病的患者。在中位随访期205天内，有自身免疫性疾病的患者发生45例心血管事件，对照组发生22例心血管事件（调整后的风险比：1.77；95%置信区间：1.04 - 3.03；P = 0.0364）。在非心血管免疫相关不良事件中，有自身免疫性疾病的患者银屑病发生率（11.2%对0.4%；P < 0.001）和结肠炎发生率（24.3%对16.7%；P = 0.045）有所增加。
已有自身免疫性疾病的患者在接受ICI治疗后发生心血管和非心血管事件的风险增加。
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