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首页> 外文期刊>Therapeutic advances in musculoskeletal disease. >Prevalence, therapy and tumour response in patients with rheumatic immune-related adverse events following immune checkpoint inhibitor therapy: a single-centre analysis
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Prevalence, therapy and tumour response in patients with rheumatic immune-related adverse events following immune checkpoint inhibitor therapy: a single-centre analysis

机译：免疫检查点抑制作用后风湿免疫相关不良事件患者的患病率，治疗和肿瘤反应：单中心分析

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Background: Immune checkpoint inhibitors (ICIs) improved cancer therapy by inducing a higher immune system activity. This effect can cause rheumatic immune-related adverse events (rh-irAEs), which have not yet been extensively studied. Methods: We analysed 437 patients between 2014 and 2019, treated with ipilimumab (anti-CTLA-4) and/or nivolumab (anti-PD-1) or pembrolizumab (anti-PD-1) at the Clinic for Internal Medicine III, Oncology, Haematology and Rheumatology at the University Hospital Bonn, Germany. Results: Of the 437 patients 60% were males. Patients were mainly treated for melanoma, lung cancer, head and neck tumour and urothelial carcinoma. At least one immune-related adverse event (irAE) was observed in 163 patients (37.3%), including rh-irAE. Most common side effects were rash, colitis and hepatitis. We identified 19 patients (4.3%) with a minimum of one rh-irAE due to ICI therapy; three of those had a pre-existing rheumatic disease. Arthralgia developed most frequently in eight patients (42.1%). Other rh-irAEs were: arthritis ( n?=?7; distinguished in rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis and undifferentiated arthritis), myalgia ( n?=?2) and myositis ( n?=?3). Most rh-irAEs were classified as moderately severe (Common Terminology Criteria of Adverse Events grade 2: 68.4%). Median time between starting ICI therapy and the occurrence of rh-irAE was 109?days (interquartile range 40–420?days). Fifteen patients (78.9%) were treated with glucocorticosteroids. In four cases additional therapy with methotrexate or tocilizumab was required. Even though patients benefited from ICI treatment, therapy had to be discontinued in six of the participants due to rh-irAE. Interestingly, patients with rh-irAE had a significantly higher tumour response compared with patients without rh-irAE (94.4% versus 43.5%; p??0.0001). Conclusion: Rh-irAEs occur under ICI therapy, especially in patients with higher tumour response. However, they are not the most frequent irAE after ICI exposure: 9.3% of all irAEs were rheumatic (20 rh-irAE cases in 19 patients of a total of 215 irAE cases in 163 patients).
机译：背景：免疫检查点抑制剂（ICIS）通过诱导更高的免疫系统活性改善癌症治疗。这种效果可以引起风湿性免疫相关的不良事件（RH-IRAES），其尚未广泛研究。方法：我们在2014年至2019年间分析了437名患者，在临床上用IPILIMIMAB（抗CTLA-4）和/或Nivolumab（抗PD-1）或PEMBROLIZUAB（抗PD-1）治疗III，肿瘤学，德国波恩大学医院血液学和风湿病学。结果：437例患者60％是男性。患者主要用于黑素瘤，肺癌，头部肿瘤和尿路上皮癌。在163名患者（37.3％）中观察到至少一种免疫相关的不良事件（IRAE），包括RH-IRAE。最常见的副作用是皮疹，结肠炎和肝炎。由于ICI治疗，我们确定了19名患者（4.3％）（4.3％），最少的一个RH-iRAE;其中三种具有预先存在的风湿病。八位患者最常发育的关节痛（42.1％）。其他Rh-Iraes是：关节炎（N？=？7;以类风湿性关节炎，银屑病关节炎，青少年特发性关节炎和未分化的关节炎），肌痛（n？=？2）和肌炎（n？=？3）。大多数RH-IRAE被归类为中度严重（常见的术语2：68.4％的不良事件的标准）。起始ICI治疗和Rh-iRAE的发生之间的中位时间为109？天（四分位数范围40-420？天）。将十五名患者（78.9％）用糖皮质激素治疗。在四种情况下，需要含有甲氨蝶呤或待密钥的额外治疗。尽管患者受益于ICI治疗，但由于RH-IRAE，六名参与者必须在六名参与者中停药。有趣的是，R RH-IRAE的患者与无RH-IRAE的患者相比具有显着更高的肿瘤反应（94.4％而与43.5％;p≤≤0.0001）。结论：Rh-Iraes在ICI治疗下进行，特别是肿瘤反应患者。然而，在ICI暴露之后，它们不是最常见的IRAE：9.3％的伊拉什是风湿性的（20例RH-IRAE病例，19例，163名患者共215例）。

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