Abstract：
BACKGROUND: An altered immune tolerance disturbed by immune checkpoint inhibitors (ICIs) may contribute to new-onset polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). This systematic literature review (SLR) examines the characteristics of PMR and GCA-like syndromes following anticancer treatment with ICIs, summarizing their demographic, clinical and treatment-related features to provide insights whether they differ from the idiopathic forms.
METHODS: The SLR was conducted in Medline and EMBASE databases from inception to July 2024, and in the EULAR/ACR abstract database (2021-2023). ICI-induced PMR and GCA syndromes were compared to the primary forms of the diseases using data from studies that included both groups as comparators. For manuscripts lacking direct comparisons, we summarized the main findings and discussed the differences using systematic reviews or large observational studies on the primary forms.
RESULTS: From 1237 screened abstracts, 46 met the inclusion criteria, involving 358 patients (314 with ICI-PMR and 44 with ICI-GCA). ICI-PMR had an estimated pooled prevalence of 0.1% [95% CI: 0.07%, 0.14%] among ICI recipients and 15.9% [95% CI: 12.6%, 19.9%] among patients experiencing rheumatic immune-related adverse events. Patients with ICI-PMR had a male-to-female ratio of 1.7:1 and a mean age of 71 ± 4 years. Most cases were associated with PD1/PDL1 blockers (87%). Clinical features included inflammatory pain in the girdles (100%), though pelvic girdle involvement was under-reported in some cases (3/28 studies). Peripheral arthritis was present in 35% of patients. Laboratory tests showed normal or slightly elevated inflammatory markers in 26% of cases. Glucocorticoids (GCs) led to symptom improvement in 84% of cases although 20% required immunosuppressive treatment and 14% experienced relapses. ICI-GCA had a prevalence of 0.06% among ICI recipients, with equal gender distribution and a mean age of 71 ± 5 years. Most patients received anti-PD1/PDL1 blockers (57%). Clinical manifestations included cephalic symptoms (75%), permanent visual loss (23%) and symptoms related to large-vessel involvement (54%). High-dose GCs were effective, with 96% achieving remission, though 17% experienced relapses.
CONCLUSIONS: ICI-induced PMR and GCA may have distinct clinical profiles compared to idiopathic forms, with potentially milder symptoms and better treatment responses. Further studies are needed to confirm these findings and better understand the long-term outcomes and pathophysiology of these conditions.
METHODS: The SLR was conducted in Medline and EMBASE databases from inception to July 2024, and in the EULAR/ACR abstract database (2021-2023). ICI-induced PMR and GCA syndromes were compared to the primary forms of the diseases using data from studies that included both groups as comparators. For manuscripts lacking direct comparisons, we summarized the main findings and discussed the differences using systematic reviews or large observational studies on the primary forms.
RESULTS: From 1237 screened abstracts, 46 met the inclusion criteria, involving 358 patients (314 with ICI-PMR and 44 with ICI-GCA). ICI-PMR had an estimated pooled prevalence of 0.1% [95% CI: 0.07%, 0.14%] among ICI recipients and 15.9% [95% CI: 12.6%, 19.9%] among patients experiencing rheumatic immune-related adverse events. Patients with ICI-PMR had a male-to-female ratio of 1.7:1 and a mean age of 71 ± 4 years. Most cases were associated with PD1/PDL1 blockers (87%). Clinical features included inflammatory pain in the girdles (100%), though pelvic girdle involvement was under-reported in some cases (3/28 studies). Peripheral arthritis was present in 35% of patients. Laboratory tests showed normal or slightly elevated inflammatory markers in 26% of cases. Glucocorticoids (GCs) led to symptom improvement in 84% of cases although 20% required immunosuppressive treatment and 14% experienced relapses. ICI-GCA had a prevalence of 0.06% among ICI recipients, with equal gender distribution and a mean age of 71 ± 5 years. Most patients received anti-PD1/PDL1 blockers (57%). Clinical manifestations included cephalic symptoms (75%), permanent visual loss (23%) and symptoms related to large-vessel involvement (54%). High-dose GCs were effective, with 96% achieving remission, though 17% experienced relapses.
CONCLUSIONS: ICI-induced PMR and GCA may have distinct clinical profiles compared to idiopathic forms, with potentially milder symptoms and better treatment responses. Further studies are needed to confirm these findings and better understand the long-term outcomes and pathophysiology of these conditions.
摘要：
背景：受免疫检查点抑制剂（ICIs）干扰的免疫耐受改变可能导致新发风湿性多肌痛（PMR）和巨细胞动脉炎（GCA）。本系统文献综述（SLR）研究了ICIs抗癌治疗后PMR和GCA样综合征的特征，总结他们的人口统计，临床和治疗相关特征，以提供它们是否与特发性形式不同的见解。
方法：SLR从开始到2024年7月在Medline和EMBASE数据库中进行，并在EULAR/ACR摘要数据库（2021-2023年）中进行。使用包括两组作为比较物的研究数据，将ICI诱导的PMR和GCA综合征与疾病的主要形式进行了比较。对于缺乏直接比较的手稿，我们总结了主要发现,并使用系统综述或主要形式的大型观察性研究讨论了差异.
结果：来自1237份筛选摘要，46符合纳入标准，涉及358例患者（314例ICI-PMR和44例ICI-GCA）。ICI-PMR的汇总患病率估计为0.1%[95%CI：0.07%，ICI接受者中的0.14%]和15.9%[95%CI：12.6%，19.9%]患者出现风湿性免疫相关不良事件。ICI-PMR患者的男女比例为1.7：1，平均年龄为71±4岁。大多数病例与PD1/PDL1受体阻滞剂相关（87％）。临床特征包括腰带炎性疼痛（100%），尽管在某些病例中骨盆带受累的报道不足（3/28研究）。35%的患者存在周围性关节炎。实验室检查显示26％的病例中炎症标志物正常或轻度升高。糖皮质激素（GC）导致84％的病例症状改善，尽管20％的病例需要免疫抑制治疗，而14％的病例经历了复发。ICI-GCA在ICI接受者中的患病率为0.06％，性别分布相等，平均年龄71±5岁。大多数患者接受抗PD1/PDL1阻断剂（57％）。临床表现包括头部症状（75％），永久性视力丧失（23％）和与大血管受累有关的症状（54％）。高剂量GCs是有效的,96%达到缓解，尽管17%经历了复发。
结论：与特发性形式相比，ICI诱导的PMR和GCA可能具有不同的临床特征，具有潜在的轻度症状和更好的治疗反应。需要进一步的研究来证实这些发现，并更好地了解这些疾病的长期结果和病理生理学。
方法：SLR从开始到2024年7月在Medline和EMBASE数据库中进行，并在EULAR/ACR摘要数据库（2021-2023年）中进行。使用包括两组作为比较物的研究数据，将ICI诱导的PMR和GCA综合征与疾病的主要形式进行了比较。对于缺乏直接比较的手稿，我们总结了主要发现,并使用系统综述或主要形式的大型观察性研究讨论了差异.
结果：来自1237份筛选摘要，46符合纳入标准，涉及358例患者（314例ICI-PMR和44例ICI-GCA）。ICI-PMR的汇总患病率估计为0.1%[95%CI：0.07%，ICI接受者中的0.14%]和15.9%[95%CI：12.6%，19.9%]患者出现风湿性免疫相关不良事件。ICI-PMR患者的男女比例为1.7：1，平均年龄为71±4岁。大多数病例与PD1/PDL1受体阻滞剂相关（87％）。临床特征包括腰带炎性疼痛（100%），尽管在某些病例中骨盆带受累的报道不足（3/28研究）。35%的患者存在周围性关节炎。实验室检查显示26％的病例中炎症标志物正常或轻度升高。糖皮质激素（GC）导致84％的病例症状改善，尽管20％的病例需要免疫抑制治疗，而14％的病例经历了复发。ICI-GCA在ICI接受者中的患病率为0.06％，性别分布相等，平均年龄71±5岁。大多数患者接受抗PD1/PDL1阻断剂（57％）。临床表现包括头部症状（75％），永久性视力丧失（23％）和与大血管受累有关的症状（54％）。高剂量GCs是有效的,96%达到缓解，尽管17%经历了复发。
结论：与特发性形式相比，ICI诱导的PMR和GCA可能具有不同的临床特征，具有潜在的轻度症状和更好的治疗反应。需要进一步的研究来证实这些发现，并更好地了解这些疾病的长期结果和病理生理学。
