Rheumatic Immune-Related Adverse Events due to Immune Checkpoint Inhibitors-A 2023 Update
Quang Minh Dang1, Ryu Watanabe1, Mayu Shiomi1
1Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 565-0871, Japan.
Abstract:
With the aging of the population, malignancies are becoming common complications in patients with rheumatoid arthritis (RA), particularly in elderly patients. Such malignancies often interfere with RA treatment. Among several therapeutic agents, immune checkpoint inhibitors (ICIs) which antagonize immunological brakes on T lymphocytes have emerged as a promising treatment option for a variety of malignancies. In parallel, evidence has accumulated that ICIs are associated with numerous immune-related adverse events (irAEs), such as hypophysitis, myocarditis, pneumonitis, and colitis. Moreover, ICIs not only exacerbate pre-existing autoimmune diseases, but also cause de novo rheumatic disease-like symptoms, such as arthritis, myositis, and vasculitis, which are currently termed rheumatic irAEs. Rheumatic irAEs differ from classical rheumatic diseases in multiple aspects, and treatment should be individualized based on the severity. Close collaboration with oncologists is critical for preventing irreversible organ damage. This review summarizes the current evidence regarding the mechanisms and management of rheumatic irAEs with focus on arthritis, myositis, and vasculitis. Based on these findings, potential therapeutic strategies against rheumatic irAEs are discussed.
Insights
Immune checkpoint inhibitors (ICIs) treat cancer but can cause rheumatic immune-related adverse events (irAEs) like arthritis. Early recognition and individualized treatment are key for managing these side effects in patients with rheumatoid arthritis.
Area of Science:
- Rheumatology
- Oncology
- Immunology
Background:
- Malignancies are common in aging rheumatoid arthritis (RA) patients, complicating treatment.
- Immune checkpoint inhibitors (ICIs) are effective cancer therapies but can cause immune-related adverse events (irAEs).
- Rheumatic irAEs, including arthritis, myositis, and vasculitis, can arise from ICI use, mimicking autoimmune diseases.
Purpose of the Study:
- To review the mechanisms and management of rheumatic irAEs.
- To focus on arthritis, myositis, and vasculitis as key rheumatic irAEs.
- To discuss potential therapeutic strategies for rheumatic irAEs.
Main Methods:
- Literature review of current evidence on rheumatic irAEs.
- Analysis of ICI mechanisms and their impact on rheumatic conditions.
- Synthesis of findings for therapeutic strategy development.
Main Results:
- ICIs can exacerbate pre-existing autoimmune diseases like RA.
- New-onset rheumatic symptoms (arthritis, myositis, vasculitis) are termed rheumatic irAEs.
- Rheumatic irAEs require individualized treatment and close oncological collaboration.
Conclusions:
- Rheumatic irAEs present unique challenges compared to classical rheumatic diseases.
- Management necessitates a tailored approach based on severity.
- Collaboration between rheumatologists and oncologists is crucial to prevent organ damage.
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