Hydroxychloroquine is a safe and effective steroid-sparing agent for immune checkpoint inhibitor–induced inflammatory arthritis

Roberts, Janet; Smylie, Michael; Walker, John; Basappa, Naveen S.; Chu, Quincy Siu-Chung; Kolinsky, Michael; Lyddell, Christopher; Ye, Carrie

doi:10.1007/s10067-019-04451-2

Cited by 48 publications

(19 citation statements)

References 19 publications

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“…In recent years, immunotherapy has become a potential cancer therapy because the immunosuppressive immune system could recognize and eradicate tumor cells together with generating a durable response to tumor antigen. , Among immunotherapies, the blockade of immune checkpoints is considered an effective strategy . Furthermore, tumor-overexpressing indoleamine 2,3-dioxygenase (IDO) has known as an immunosuppressive enzyme or such an immune checkpoint that causes anergy and apoptosis of CD8 + T cells along with promoting immunosuppression .…”

Section: Potential Photosensitizers For Hypoxic Tumor Photodynamic Th...mentioning

confidence: 99%

Recent Strategies to Develop Innovative Photosensitizers for Enhanced Photodynamic Therapy

et al. 2021

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This review presents a robust strategy to design photosensitizers (PSs) for various species. Photodynamic therapy (PDT) is a photochemical-based treatment approach that involves the use of light combined with a light-activated chemical, referred to as a PS. Attractively, PDT is one of the alternatives to conventional cancer treatment due to its noninvasive nature, high cure rates, and low side effects. PSs play an important factor in photoinduced reactive oxygen species (ROS) generation. Although the concept of photosensitizer-based photodynamic therapy has been widely adopted for clinical trials and bioimaging, until now, to our surprise, there has been no relevant review article on rational designs of organic PSs for PDT. Furthermore, most of published review articles in PDT focused on nanomaterials and nanotechnology based on traditional PSs. Therefore, this review aimed at reporting recent strategies to develop innovative organic photosensitizers for enhanced photodynamic therapy, with each example described in detail instead of providing only a general overview, as is typically done in previous reviews of PDT, to provide intuitive, vivid, and specific insights to the readers.

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Section: Potential Photosensitizers For Hypoxic Tumor Photodynamic Th...mentioning

confidence: 99%

Recent Strategies to Develop Innovative Photosensitizers for Enhanced Photodynamic Therapy

et al. 2021

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“…165 One case series reported the initiation of hydroxychloroquine prior to glucocorticoids, limiting glucocorticoid exposure, which would deserve further evaluation. 166 The use of csDMARDs has not been described for patients with CPI-induced sicca syndrome. Two patients received hydroxychloroquine and one the combination of hydroxychloroquine and methotrexate for cutaneous leucocytoclastic vasculitis.…”

Section: Recommendationmentioning

confidence: 99%

EULAR points to consider for the diagnosis and management of rheumatic immune-related adverse events due to cancer immunotherapy with checkpoint inhibitors

et al. 2020

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BackgroundRheumatic and musculoskeletal immune-related adverse events (irAEs) are observed in about 10% of patients with cancer receiving checkpoint inhibitors (CPIs). Given the recent emergence of these events and the lack of guidance for rheumatologists addressing them, a European League Against Rheumatism task force was convened to harmonise expert opinion regarding their identification and management.MethodsFirst, the group formulated research questions for a systematic literature review. Then, based on literature and using a consensus procedure, 4 overarching principles and 10 points to consider were developed.ResultsThe overarching principles defined the role of rheumatologists in the management of irAEs, highlighting the shared decision-making process between patients, oncologists and rheumatologists. The points to consider inform rheumatologists on the wide spectrum of musculoskeletal irAEs, not fulfilling usual classification criteria of rheumatic diseases, and their differential diagnoses. Early referral and facilitated access to rheumatologist are recommended, to document the target organ inflammation. Regarding therapeutic, three treatment escalations were defined: (1) local/systemic glucocorticoids if symptoms are not controlled by symptomatic treatment, then tapered to the lowest efficient dose, (2) conventional synthetic disease-modifying antirheumatic drugs, in case of inadequate response to glucocorticoids or for steroid sparing and (3) biological disease-modifying antirheumatic drugs, for severe or refractory irAEs. A warning has been made on severe myositis, a life-threatening situation, requiring high dose of glucocorticoids and close monitoring. For patients with pre-existing rheumatic disease, baseline immunosuppressive regimen should be kept at the lowest efficient dose before starting immunotherapies.ConclusionThese statements provide guidance on diagnosis and management of rheumatic irAEs and aim to support future international collaborations.

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“…Hydroxychloroquine is a commonly used DMARD for low grade ICI-arthritis 40 and is thought to be immunomodulatory rather than immunosuppressive (ie, it is not associated with an increased risk of infection). A recent preclinical study suggested that hydroxychloroquine may impair anti-PD-1 associated reductions in tumor growth 68 but the hydroxychloroquine dosages used in that study (the equivalent of 600 mg in humans) was higher than is used in rheumatology practice (typically 200–400 mg).…”

Section: Ici-arthritis Managementmentioning

confidence: 99%

Monitoring and Management of the Patient with Immune Checkpoint Inhibitor-Induced Inflammatory Arthritis: Current Perspectives

Chan¹,

Bass²

2022

JIR

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In this review, we draw from observational studies, treatment guidelines and our own clinical experience to describe approaches to monitoring and management of immune checkpoint inhibitor (ICI)-induced inflammatory arthritis, including polymyalgia rheumatica. This condition occurs in about 4% of ICI-treated cancer patients and can persist for a year or longer. Mild arthritis can generally be managed with non-steroidal anti-inflammatory drugs, intraarticular steroids injections and/or low dose corticosteroids. Higher grade arthritis should be brought under control with corticosteroids, but early introduction of a steroid-sparing agent is recommended to minimize steroid toxicity. In order to assess the effectiveness of any arthritis treatment, tender and swollen joint counts and patient reported measures of physical function, such as the health assessment questionnaire, should be obtained at each visit. Referral to a rheumatologist is recommended for patients with high grade arthritis to help guide the use of disease-modifying antirheumatic drugs.

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Hydroxychloroquine is a safe and effective steroid-sparing agent for immune checkpoint inhibitor–induced inflammatory arthritis

Cited by 48 publications

References 19 publications

Recent Strategies to Develop Innovative Photosensitizers for Enhanced Photodynamic Therapy

Recent Strategies to Develop Innovative Photosensitizers for Enhanced Photodynamic Therapy

EULAR points to consider for the diagnosis and management of rheumatic immune-related adverse events due to cancer immunotherapy with checkpoint inhibitors

Monitoring and Management of the Patient with Immune Checkpoint Inhibitor-Induced Inflammatory Arthritis: Current Perspectives

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