Immune-related adverse events in patients with solid-organ tumours treated with immunotherapy: a 3-year study of 102 cases from a single centre

González-Mazón, I.; Sánchez-Bilbao, L.; Martín-Varillas, J. L.; García‐Castaño, Almudena; Delgado-Ruiz, Marina; Piña, Isabel Bernat; Hernández, José L.; Castañeda, Santos; Llorca, Javier; Blanco, R.

doi:10.55563/clinexprheumatol/o5nvgv

Cited by 10 publications

(4 citation statements)

References 36 publications

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“…However, due to the ICD codes used, secondary myositis syndromes were also classified as “other myositis”, as there are overlaps in the coding (e.g., G72.0 Drug-induced myopathy). However, in light of the rarity of these secondary causes [ 17 – 19 ], it can be assumed that the present data are only slightly influenced by this classification of “other myositis”. The increasing prevalence of myositis in older age shown in recent years may be explained, regarding the discrepancy with previous work, by increasing life expectancy [ 11 ].…”

Section: Discussionmentioning

confidence: 80%

Myositis in Germany: epidemiological insights over 15 years from 2005 to 2019

Pawlitzki

Acar

Masanneck

et al. 2022

Neurol. Res. Pract.

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Background The medical care of patients with myositis is a great challenge in clinical practice. This is due to the rarity of these disease, the complexity of diagnosis and management as well as the lack of systematic analyses. Objectives Therefore, the aim of this project was to obtain an overview of the current care of myositis patients in Germany and to evaluate epidemiological trends in recent years. Methods In collaboration with BARMER Insurance, retrospective analysis of outpatient and inpatient data from an average of approximately 8.7 million insured patients between January 2005 and December 2019 was performed using ICD-10 codes for myositis for identification of relevant data. In addition, a comparative analysis was performed between myositis patients and an age-matched comparison group from other populations insured by BARMER. Results 45,800 BARMER-insured individuals received a diagnosis of myositis during the observation period, with a relatively stable prevalence throughout. With regard to comorbidities, a significantly higher rate of cardiovascular disease as well as neoplasm was observed compared to the control group within the BARMER-insured population. In addition, myositis patients suffer more frequently from psychiatric disorders, such as depression and somatoform disorders. However, the ICD-10 catalogue only includes the specific coding of “dermatomyositis” and “polymyositis” and thus does not allow for a sufficient analysis of all idiopathic inflammatory myopathies subtypes. Conclusion The current data provide a comprehensive epidemiological analysis of myositis in Germany, highlighting the multimorbidity of myositis patients. This underlines the need for multidisciplinary management. However, the ICD-10 codes currently still in use do not allow for specific analysis of the subtypes of myositis. The upcoming ICD-11 coding may improve future analyses in this regard.

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Section: Discussionmentioning

confidence: 80%

Myositis in Germany: epidemiological insights over 15 years from 2005 to 2019

Pawlitzki

Acar

Masanneck

et al. 2022

Neurol. Res. Pract.

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“…According to PRISMA guidelines, we performed a medical literature search across several databases (PubMed, Medline, Google Scholar) using the search terms “immune checkpoint inhibitor-induced psoriasis/psoriasiform dermatitis/psoriasis arthritis”. We identified and revised 80 relevant publications and included the most important data provided by these studies in Table S1 [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ,…”

Section: Review Of the Literaturementioning

confidence: 99%

Perspectives on Psoriasiform Adverse Events from Immune Checkpoint Inhibitors: Lessons Learned from Our Practice

Popa,

Giurcaneanu,

Portelli

et al. 2024

Medicina

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Background: New oncologic therapies, including immune checkpoint inhibitors (ICIs), have revolutionized the survival and prognosis of cancer patients. However, these therapies are often complicated by immune-related adverse effects (irAEs) that may impact quality of life and potentially limit their use. Among these adverse events are psoriasis and psoriatic arthritis that may develop de novo or flare under treatment with ICIs. Given the exceptional immune status of patients receiving ICIs, managing these conditions without interfering with the effect of the oncologic treatment may prove very challenging. Aim: To review the literature data on ICI-induced psoriasis exacerbation or development, to present our own experience, and to discuss the pathogenic mechanisms underlying this association and the optimal therapeutic approach for these patients. Case Reports: We report three cases of ICI-induced de novo psoriasis and two cases of ICI-induced psoriasis exacerbation that required systemic treatment. Oral acitretin treatment successfully controlled psoriasis lesions in three cases and allowed for the continuation of immunotherapy. Literature Review: We performed a medical literature search across several databases (PubMed, Medline, Google Scholar) using the search terms “immune checkpoint inhibitor-induced psoriasis/psoriasiform dermatitis/psoriasis arthritis”. We identified and revised 80 relevant publications that reported 1102 patients with psoriasis and/or psoriasis arthritis induced or exacerbated by ICIs. We assessed the type of cancer, the therapeutic agent involved, the clinical form of psoriasis, the presence or absence of psoriatic arthritis, the personal and family history of psoriasis, the age, the gender, the time until onset or exacerbation of skin lesions, the specific treatment recommended, the need for ICI discontinuation, and the patient’s outcome. Conclusions: As ICIs represent a fairly novel therapy, the association with several adverse effects is only now unraveling. Psoriasis exacerbation or onset following the initiation of immunotherapy is one such example, as more and more reports and case series are being published. Awareness of the relationship between psoriasis and treatment with ICIs, prompt recognition, and initiation of adequate skin-directed therapies are essential for the avoidance of skin lesions worsening, the need for systemic treatments that may interfere with ICIs’ effects, or the discontinuation of the latter. In the absence of generally accepted guidelines, it is advisable to treat patients with severe, widespread psoriasis with drugs that do not impair the effects of immunotherapy and thus do not alter the patient’s prognosis.

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“…In parallel with their success against malignancies, ICIs induce potentially severe and even lethal side effects called irAEs, which are considered off-target tissue damage and involve essentially every organ system [ 17 ]. A wide range of irAEs have been described [ 34 , 35 ], including hypophysitis, thyroiditis, myocarditis, pneumonia, pancreatitis, hepatitis, nephritis, adrenal insufficiency, enteritis, and skin rash ( Figure 1 ). Although the underlying mechanisms of irAEs are not fully understood, (1) aberrant cytotoxic T cell activation, (2) increased autoantibody production, (3) direct molecular mimicry, (4) inflammatory cytokine production, (5) complement-mediated inflammation, (6) imparted regulatory T cell function, and other mechanisms contribute to the immunopathology of irAEs [ 17 , 19 , 36 , 37 , 38 ].…”

Section: Immune-related Adverse Events (Iraes)mentioning

confidence: 99%

Rheumatic Immune-Related Adverse Events due to Immune Checkpoint Inhibitors—A 2023 Update

Dang¹,

Watanabe²,

Shiomi³

et al. 2023

IJMS

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With the aging of the population, malignancies are becoming common complications in patients with rheumatoid arthritis (RA), particularly in elderly patients. Such malignancies often interfere with RA treatment. Among several therapeutic agents, immune checkpoint inhibitors (ICIs) which antagonize immunological brakes on T lymphocytes have emerged as a promising treatment option for a variety of malignancies. In parallel, evidence has accumulated that ICIs are associated with numerous immune-related adverse events (irAEs), such as hypophysitis, myocarditis, pneumonitis, and colitis. Moreover, ICIs not only exacerbate pre-existing autoimmune diseases, but also cause de novo rheumatic disease–like symptoms, such as arthritis, myositis, and vasculitis, which are currently termed rheumatic irAEs. Rheumatic irAEs differ from classical rheumatic diseases in multiple aspects, and treatment should be individualized based on the severity. Close collaboration with oncologists is critical for preventing irreversible organ damage. This review summarizes the current evidence regarding the mechanisms and management of rheumatic irAEs with focus on arthritis, myositis, and vasculitis. Based on these findings, potential therapeutic strategies against rheumatic irAEs are discussed.

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Immune-related adverse events in patients with solid-organ tumours treated with immunotherapy: a 3-year study of 102 cases from a single centre

Cited by 10 publications

References 36 publications

Myositis in Germany: epidemiological insights over 15 years from 2005 to 2019

Myositis in Germany: epidemiological insights over 15 years from 2005 to 2019

Perspectives on Psoriasiform Adverse Events from Immune Checkpoint Inhibitors: Lessons Learned from Our Practice

Rheumatic Immune-Related Adverse Events due to Immune Checkpoint Inhibitors—A 2023 Update

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