Abstract：
OBJECTIVE: Immune checkpoint inhibitor (ICI) associated inflammatory arthritis (ICI-IA) occurs in 4-6% of ICI-treated patients based on one observational study. We identified cases of ICI-IA using administrative claims to study its incidence and characteristics at the population level.
METHODS: We used the Medicare 5% sample to identify patients initiating ICIs. Cancer patients were identified by having ≥ 2 ICD-9/10-CM diagnosis codes from an oncologist for lung cancer, melanoma, or renal/urothelial cancer. ICI-IA was defined as having two Medicare claims ≥ 30 days apart with combinations of ICD-9/10-CM diagnosis codes that favored specificity. ICI-IA was identified in patients with a musculoskeletal diagnosis after ICI initiation, who had i.) no inflammatory arthritis or inflammatory rheumatic disease before ICI initiation ever, and ii) no musculoskeletal complaint in the one year prior to ICI. We examined DMARD utilization and visits to rheumatology in patients with ICI-IA. Landmark analysis and a time varying Cox proportional hazards model for overall survival was constructed.
RESULTS: The incidence of ICI-IA was 7.2 (6.1-8.4) per 100 patient years. Patients with ICI-IA were mean (SD) age 73.5(7.0) years, 48% women, 91% white. Median(IQR) time from ICI initiation to first ICI-IA diagnosis was 124(56, 252) days. Only 24(16%) received care from a rheumatologist, and 24(16%) were prescribed a DMARD (46% by a rheumatologist). The HR for mortality in patients with ICI-IA was 0.86 (95% CI 0.59-1.26, p= 0.45).
CONCLUSIONS: The incidence of ICI-IA identified in claims data is similar to that reported in observational studies, however, few patients are treated with a DMARD or see a rheumatologist. There was no difference in overall survival between ICI-treated patients with and without ICI-IA.
METHODS: We used the Medicare 5% sample to identify patients initiating ICIs. Cancer patients were identified by having ≥ 2 ICD-9/10-CM diagnosis codes from an oncologist for lung cancer, melanoma, or renal/urothelial cancer. ICI-IA was defined as having two Medicare claims ≥ 30 days apart with combinations of ICD-9/10-CM diagnosis codes that favored specificity. ICI-IA was identified in patients with a musculoskeletal diagnosis after ICI initiation, who had i.) no inflammatory arthritis or inflammatory rheumatic disease before ICI initiation ever, and ii) no musculoskeletal complaint in the one year prior to ICI. We examined DMARD utilization and visits to rheumatology in patients with ICI-IA. Landmark analysis and a time varying Cox proportional hazards model for overall survival was constructed.
RESULTS: The incidence of ICI-IA was 7.2 (6.1-8.4) per 100 patient years. Patients with ICI-IA were mean (SD) age 73.5(7.0) years, 48% women, 91% white. Median(IQR) time from ICI initiation to first ICI-IA diagnosis was 124(56, 252) days. Only 24(16%) received care from a rheumatologist, and 24(16%) were prescribed a DMARD (46% by a rheumatologist). The HR for mortality in patients with ICI-IA was 0.86 (95% CI 0.59-1.26, p= 0.45).
CONCLUSIONS: The incidence of ICI-IA identified in claims data is similar to that reported in observational studies, however, few patients are treated with a DMARD or see a rheumatologist. There was no difference in overall survival between ICI-treated patients with and without ICI-IA.
摘要：
目的：根据一项观察性研究，免疫检查点抑制剂（ICI）相关的炎性关节炎（ICI-IA）发生在4-6％的ICI治疗患者中。我们使用行政索赔来确定ICI-IA的病例，以研究其在人群水平上的发病率和特征。
方法：我们使用Medicare5%样本来识别启动ICIs的患者。癌症患者被确定为具有≥2个ICD-9/10-CM诊断代码来自肿瘤学家的肺癌，黑色素瘤，或肾/尿路上皮癌。ICI-IA被定义为两个医疗保险索赔间隔≥30天，ICD-9/10-CM诊断代码的组合有利于特异性。ICI-IA在ICI开始后诊断为肌肉骨骼的患者中被发现，I.）在ICI开始之前没有炎性关节炎或炎性风湿性疾病，和ii）在ICI之前的一年内没有肌肉骨骼投诉。我们检查了ICI-IA患者的DMARD利用率和风湿病就诊。构建了Landmark分析和随时间变化的Cox比例风险模型。
结果：ICI-IA的发生率为7.2（6.1-8.4）/100患者年。ICI-IA患者平均(SD)年龄73.5(7.0)岁，48%的女性，91%白色。从ICI开始到首次ICI-IA诊断的中位数（IQR）时间为124（56,252）天。只有24人（16%）接受过风湿病专家的治疗，24人(16%)接受了DMARD(46%由风湿病学家).ICI-IA患者死亡率的HR为0.86（95％CI0.59-1.26，p=0.45）。
结论：索赔数据中确定的ICI-IA的发生率与观察性研究中报告的相似，然而,很少有患者接受DMARD治疗或看风湿病专家。有和没有ICI-IA的ICI治疗患者的总生存期没有差异。
方法：我们使用Medicare5%样本来识别启动ICIs的患者。癌症患者被确定为具有≥2个ICD-9/10-CM诊断代码来自肿瘤学家的肺癌，黑色素瘤，或肾/尿路上皮癌。ICI-IA被定义为两个医疗保险索赔间隔≥30天，ICD-9/10-CM诊断代码的组合有利于特异性。ICI-IA在ICI开始后诊断为肌肉骨骼的患者中被发现，I.）在ICI开始之前没有炎性关节炎或炎性风湿性疾病，和ii）在ICI之前的一年内没有肌肉骨骼投诉。我们检查了ICI-IA患者的DMARD利用率和风湿病就诊。构建了Landmark分析和随时间变化的Cox比例风险模型。
结果：ICI-IA的发生率为7.2（6.1-8.4）/100患者年。ICI-IA患者平均(SD)年龄73.5(7.0)岁，48%的女性，91%白色。从ICI开始到首次ICI-IA诊断的中位数（IQR）时间为124（56,252）天。只有24人（16%）接受过风湿病专家的治疗，24人(16%)接受了DMARD(46%由风湿病学家).ICI-IA患者死亡率的HR为0.86（95％CI0.59-1.26，p=0.45）。
结论：索赔数据中确定的ICI-IA的发生率与观察性研究中报告的相似，然而,很少有患者接受DMARD治疗或看风湿病专家。有和没有ICI-IA的ICI治疗患者的总生存期没有差异。
