■描述由免疫检查点抑制剂(ICI)诱导的风湿性免疫相关不良事件(irAE)的不同临床模式及其风湿性和肿瘤学结果。
■我们根据五个不同类别对临床综合征进行了分类:非炎症性关节痛(NIA),类风湿性关节炎(RA),银屑病关节炎(PsA)样,风湿性多肌痛(PMR)样,和一组其他综合征的患者。我们进行了基线访问,然后进行了随访,以确定他们的临床模式,治疗反应,和结果。
■我们包括73名患者(64%为男性),平均年龄为66.1±11.6岁。29例(39%)患者的主要潜在诊断为肺癌,黑色素瘤在20(27%),肾尿路上皮癌11例(15%)。主要ICI包括24例Pembrolizumab(32%),Nivolumab17(23%),阿替珠单抗7(9%)。在ICI治疗之前,73例患者中有17例患有潜在的风湿性疾病。14例患者在风湿性综合征之前或同时发生其他irAE。主要风湿病包括:类RA31例(42.4%),19年的NIA(26.0%),PMR样在10(13.7%),5例(6.8%)中PsA样,在其他人中。从ICI到irAE的中位时间为5个月(IQR3-9)。那些接受联合治疗的患者,比接受单一疗法的患者有更早的趋势(4.3个月IQR1.85-17vs.6个月IQR3-9.25,p=NS)。平均随访时间为14.0±10.8(SD,月)。在最后一次访问中,47%的患者服用糖皮质激素和11%的DMARD治疗。在最后一次访问中,13例(17.8%)患者仍有持续性关节炎,19(26%)有间歇性耀斑,39人(53.4%)有自限模式。只有15.1%的患者停止ICI治疗。
■我们根据治疗和irAE描述了不同的模式。联合ICI治疗具有较早的症状发作。表现为类RA的患者,患持续性关节炎的风险更高。在平均随访超过1年后,五分之一的患者仍患有持续性关节炎,11%的患者需要DMARD治疗.
UNASSIGNED: To describe different clinical patterns of rheumatic immune-related adverse events (irAEs) induced by immune checkpoint inhibitors (ICI) and their rheumatic and oncologic outcomes.
UNASSIGNED: We classified clinical syndromes according to five different categories: non-inflammatory arthralgias (NIA), rheumatoid arthritis (RA)-like, psoriatic arthritis (PsA)-like, polymyalgia rheumatica (PMR)-like, and a miscellaneous group of patients with other syndromes. We conducted a baseline visit and then follow-up in order to determine their clinical pattern, treatment response, and outcome.
UNASSIGNED: We included 73 patients (64% male) with a mean age of 66.1 ± 11.6 years. Main underlying diagnosis was lung carcinoma in 29 (39%) patients, melanoma in 20 (27%), and renal-urothelial cancer in 11 (15%). Main ICI included Pembrolizumab in 24 (32%), Nivolumab 17 (23%), and Atezolizumab 7 (9 %). Seventeen out of seventy-three patients had an underlying rheumatic disease before ICI treatment. Fourteen patients developed other irAEs before or simultaneously with rheumatic syndromes. Main rheumatic irAEs included: RA-like in 31 (42.4%), NIA in 19 (26.0%), PMR-like in 10 (13.7%), and PsA-like in 5 (6.8%), among others. Median time from ICI to irAEs was 5 months (IQR 3-9). Those patients who received combined therapy, had a trend for an earlier presentation than those who received monotherapy (4.3 months IQR 1.85-17 vs. 6 months IQR 3-9.25, p = NS). Mean follow-up time was 14.0 ± 10.8 (SD, months). At the last visit, 47 % were taking glucocorticoids and 11% DMARD therapy. At the last visit, 13 (17.8%) patients remained with persistent arthritis, 19 (26%) had intermittent flares, and 39 (53.4%) had a self-limited pattern. Only in 15.1% of patients ICI therapy was discontinued.
UNASSIGNED: We described different patterns according to treatment and irAEs. Combined ICI therapy had an earlier onset of symptoms. Patients who presented as RA-like, had a higher risk of persistent arthritis. After a mean follow-up of more than 1 year, one-fifth of the patients remained with persistent arthritis and 11% required DMARD therapy.