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Patients with Cancer and Immune Checkpoint Inhibitor-Induced Rheumatic irAEs Treated by DMARDs: The RHUMICI
Emmanuel Massy1,2,3, Julien Seiller1,2, Muriel Piperno1
1Centre Expert des Métastases Osseuses (CEMOS)-Service de Rhumatologie Sud, Hôpital Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), F-69310 Pierre-Bénite, France.
Cancers
|July 28, 2026
Summary
Treatment strategies for immune-related adverse events (irAEs) in patients receiving immune checkpoint inhibitors (ICIs) showed no negative impact on anti-tumour efficacy. Disease-modifying antirheumatic drugs (DMARDs) can be safely used to manage rheumatic irAEs.
Area of Science:
- Rheumatology
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) can cause immune-related adverse events (irAEs), including rheumatic manifestations in 5-10% of patients.
- Managing rheumatic irAEs is challenging due to concerns that treatments like glucocorticoids (GCs) or disease-modifying antirheumatic drugs (DMARDs) might reduce ICI anti-tumour efficacy.
- The oncological safety of DMARDs for rheumatic irAEs is not well-characterized.
Purpose of the Study:
- To evaluate the oncological safety of different treatment strategies for rheumatic irAEs.
- To assess the impact of GCs and DMARDs on anti-tumour efficacy in patients treated with ICIs.
Main Methods:
- Retrospective observational study of 55 patients with rheumatic irAEs treated with ICIs.
- Patients were grouped into: symptomatic treatment alone (n=11), GCs only (n=27), or DMARDs (csDMARDs/bDMARDs) (n=17).
- Overall survival (OS) and progression-free survival (PFS) were compared using Kaplan-Meier analysis.
Main Results:
- The most common irAEs were undifferentiated arthritis, rheumatoid arthritis-like presentations, and polymyalgia rheumatica.
- Patients receiving DMARDs had more severe irAEs and higher baseline CRP, indicating a greater disease burden.
- No significant differences in OS or PFS were observed between treatment groups over a median follow-up of 34 months.
Conclusions:
- No detrimental oncological safety signal was identified for any rheumatic irAE treatment strategy, including DMARDs.
- DMARDs can be cautiously used as GC-sparing agents for rheumatic irAEs when clinically indicated.
- Prospective trials are needed to optimize immunosuppressive management in ICI-treated patients.
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