Do Immune Checkpoint Inhibitors Cause Flareups in Autoimmune Diseases?

A retrospective study found that patients with preexisting autoimmune diseases (PADs) may experience exacerbations during immune checkpoint inhibitor (ICI) treatment, even with background immunosuppression, although these exacerbations tend to be mild.

The study evaluated 27 patients with PAD who were referred for rheumatologic evaluation either before initiating or during immunotherapy treatment between January 2013 and July 2019.

The most prevalent PADs were rheumatoid arthritis (RA, 30%), psoriasis/psoriatic arthritis (30%), inflammatory bowel disease (IBD, 15%), and axial spondyloarthritis (AxSpA, 11%), and the most prevalent cancers were lung cancer and melanoma. Anti-PD-1 therapies were given to all patients; two patients also received sequential anti-CTLA-4 therapy.

Over a median follow-up of 11 months (interquartile range, 6-17.5 months), about half of patients experienced disease exacerbations (52%); 14% were severe. Flares necessitated corticosteroids (57%), immunosuppression (50%), and ICI discontinuation (14%). A correlation was observed between a history of more intensive immunosuppression and increased risk for exacerbations.

Patients with psoriasis, IBD, and AxSpA were susceptible to rheumatic immune-related adverse events (IRAEs) such as polyarthritis and tenosynovitis.

The study was published in Cancer Immunology, Immunotherapy.

A retrospective cohort study from 2019 observed similar findings. This study, which took place between January 2017 and January 2018 and consisted of three French national networks of oncology and autoimmunity experts, also included patients with PADs receiving ICIs.

A total of 112 patients were evaluated; median follow-up was 8 months. The most prevalent PADs in this study were psoriasis (n=31), RA (n=20), and IBD (n=14). At the time of ICI initiation, 24 patients were receiving immunosuppressive therapy. Overall, 53 patients exhibited a disease flare and 47 sustained other IRAE(s); these AEs necessitated immunosuppressive therapy (n=48) and permanent ICI discontinuation (n=24).

Patients who were receiving immunosuppressive therapy when ICI treatment was started had a shorter median progression-free survival (PFS, 3.8 months vs. 12 months, P=0.006). Median PFS was also shorter among patients who experienced flares or other IRAE(s).