Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Medicine, St. Agnes Hospital, Baltimore, MD, USA.
Rheumatology (Oxford). 2024 May 3;63(6):1518-1522. doi: 10.1093/rheumatology/kead438.
The objective of this study was to determine baseline risk factors for requiring immunosuppression and having persistent arthritis in patients with immune checkpoint inhibitor-induced inflammatory arthritis (ICI-inflammatory arthritis).
Participants were adults with rheumatologist diagnosed ICI-inflammatory arthritis. The primary outcome was requirement of conventional synthetic (cs) or biologic (b) DMARDs; other outcomes were persistence of inflammatory arthritis >6 months after ICI cessation and requirement of CSs. Logistic regression models evaluated associations between clinical features and primary and secondary outcomes, with adjustment for potential confounders, as appropriate.
One hundred and twenty-six patients with ICI-inflammatory arthritis were included; 53 patients (42%) required a csDMARD/bDMARD. In the univariate logistic regression analysis, higher clinical disease activity index (CDAI), tenosynovitis, longer symptom duration before first rheumatology visit and longer ICI duration were significantly associated with a higher likelihood of requiring DMARDs; in addition, there was a trend towards those treated with prior chemotherapy being less likely to need DMARDs. After adjustment, tenosynovitis, longer symptom duration and higher CDAI remained associated with requiring DMARDs, while those with prior chemotherapy were significantly less likely to require DMARDs. Combination anti-CTLA-4 (cytotoxic T-lymphocyte-associated protein-4)/PD-1 (Programmed cell death protein-1) therapy and CS use at baseline were associated with a higher risk of persistent inflammatory arthritis.
Higher levels of disease activity, tenosynovitis and longer symptom duration prior to rheumatology referral were associated with requiring DMARDs for ICI-inflammatory arthritis, while those treated previously with chemotherapy were less likely to require additional immunosuppression. The presence of risk factors for severe disease at baseline may indicate a role for higher initial CS dose, earlier rheumatology referral, and adoption of immunosuppression beyond CSs to improve outcomes.
本研究旨在确定接受免疫检查点抑制剂（ICI）诱导的炎症性关节炎（ICI-IA）治疗的患者需要免疫抑制和持续性关节炎的基线风险因素。
研究对象为风湿科诊断为 ICI-IA 的成年人。主要结局是需要常规合成（cs）或生物（b）DMARDs；其他结局是 ICI 停药后 6 个月以上炎症性关节炎的持续存在和 csDMARDs 的需求。逻辑回归模型评估了临床特征与主要和次要结局之间的关联，并根据需要进行了适当的潜在混杂因素调整。
共纳入 126 例 ICI-IA 患者，53 例（42%）患者需要 csDMARD/bDMARD。在单变量逻辑回归分析中，较高的临床疾病活动指数（CDAI）、腱鞘炎、首次就诊前症状持续时间较长和 ICI 持续时间较长与更有可能需要 DMARDs 显著相关；此外，先前接受化疗治疗的患者不太可能需要 DMARDs。调整后，腱鞘炎、较长的症状持续时间和较高的 CDAI 与需要 DMARDs 相关，而先前接受化疗的患者不太可能需要 DMARDs。联合抗 CTLA-4（细胞毒性 T 淋巴细胞相关蛋白 4）/PD-1（程序性细胞死亡蛋白 1）治疗和基线时使用 CS 与持续性炎症性关节炎的风险增加相关。
在接受 ICI-IA 治疗的患者中，较高的疾病活动度、腱鞘炎和症状出现前较长的时间与需要 DMARDs 相关，而先前接受化疗治疗的患者不太可能需要额外的免疫抑制治疗。基线时存在严重疾病的危险因素可能表明需要更高的初始 CS 剂量、更早的风湿科转诊以及在 CS 之外采用免疫抑制治疗以改善结局。
