Poorer survival for patients with inflammatory arthritis treated with immune checkpoint inhibitors for melanoma

IF 7.9 1区医学 Q1 IMMUNOLOGY

Journal of autoimmunity Pub Date : 2025-03-01 DOI:10.1016/j.jaut.2025.103400

H.B. Tenstad , C.H. Ruhlmann , S. Möller , S. Kjaer , L. Bastholt , S.A. Just , H. Lindegaard

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Abstract

Background

Patients with inflammatory arthritis treated with immune checkpoint inhibitors (ICIs) for melanoma face unique challenges, including disease flares and reduced treatment efficacy. Evidence on the survival impact of pre-existing arthritis in this population remains limited.

Methods

We conducted an observational cohort study using data from two Danish national registries, DANBIO and DAMMED, including patients with melanoma and pre-existing inflammatory arthritis treated with ICIs. Cases were matched with controls without arthritis based on sex, age, melanoma subtype, disease stage, and treatment regimen. Outcomes included overall survival (OS), progression-free survival (PFS)/recurrence-free survival (RFS), changes in rheumatic disease activity, and healthcare utilization.

Results

Seventy-five patients with inflammatory arthritis were identified, initiating 91 ICI treatment courses. Patients with arthritis demonstrated poorer OS (HR 1.4, 95 % CI: 1.04–1.91) and PFS/RFS (HR 1.5, 95 % CI: 1.13–1.94) compared to controls. Subgroup analysis of immunosuppressed patients yielded similar results. Rheumatic disease activity increased post-ICI initiation (mean DAS28 Δ +0.48, p = 0.001), while rheumatologic healthcare utilization decreased.

Conclusion

Patients with inflammatory arthritis have poorer OS and PFS/RFS following ICI therapy for melanoma, partly attributable to baseline immunosuppressive treatment. These findings underscore the need for enhanced multidisciplinary management to optimize outcomes and address the survival gap in this population.

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使用免疫检查点抑制剂治疗黑色素瘤的炎症性关节炎患者生存率较低

使用免疫检查点抑制剂（ICIs）治疗黑色素瘤的炎症性关节炎患者面临着独特的挑战，包括疾病发作和治疗效果降低。在这一人群中，先前存在的关节炎对生存影响的证据仍然有限。方法：我们使用丹麦两个国家登记处DANBIO和DAMMED的数据进行了一项观察性队列研究，包括接受ICIs治疗的黑色素瘤和既往炎症性关节炎患者。根据性别、年龄、黑色素瘤亚型、疾病分期和治疗方案，将病例与无关节炎的对照组相匹配。结果包括总生存期（OS）、无进展生存期(PFS)/无复发生存期（RFS）、风湿病活动性的变化和医疗保健利用。结果确诊炎性关节炎75例，91个疗程ICI治疗。与对照组相比，关节炎患者表现出较差的OS （HR 1.4, 95% CI: 1.04-1.91）和PFS/RFS （HR 1.5, 95% CI: 1.13-1.94）。免疫抑制患者的亚组分析也得到了类似的结果。ici开始后风湿病活动性增加（平均DAS28 Δ +0.48, p = 0.001），而风湿病保健利用率下降。结论炎性关节炎患者在黑色素瘤ICI治疗后OS和PFS/RFS较差，部分归因于基线免疫抑制治疗。这些发现强调了加强多学科管理的必要性，以优化结果并解决这一人群的生存差距。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of autoimmunity 医学-免疫学

CiteScore

27.90

自引率

1.60%

发文量

117

审稿时长

17 days

期刊介绍： The Journal of Autoimmunity serves as the primary publication for research on various facets of autoimmunity. These include topics such as the mechanism of self-recognition, regulation of autoimmune responses, experimental autoimmune diseases, diagnostic tests for autoantibodies, as well as the epidemiology, pathophysiology, and treatment of autoimmune diseases. While the journal covers a wide range of subjects, it emphasizes papers exploring the genetic, molecular biology, and cellular aspects of the field. The Journal of Translational Autoimmunity, on the other hand, is a subsidiary journal of the Journal of Autoimmunity. It focuses specifically on translating scientific discoveries in autoimmunity into clinical applications and practical solutions. By highlighting research that bridges the gap between basic science and clinical practice, the Journal of Translational Autoimmunity aims to advance the understanding and treatment of autoimmune diseases.