Polymyalgia rheumatica-like syndrome from checkpoint inhibitor therapy: case series and systematic review of the literature

Calabrese, Cassandra; Cappelli, Laura C.; Kostine, Marie; Kirchner, E; Braaten, Tawnie; Calabrese, Leonard H.

doi:10.1136/rmdopen-2019-000906

Cited by 67 publications

(55 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This percentage was higher (55%) for PsA (6/11), as well as in a recent series of PMR-like syndrome (37/49; 75%). 79 The first observation of recurrent pseudogout flares 7 to 10 days after each nivolumab infusion has been recently reported. 80 Several cases of myositis have been reported, with frequent limb-girdle myalgia and weakness that may mimic a PMR-like condition.…”

Section: Points To Considermentioning

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Points To Considermentioning

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

Self Cite

View full text Add to dashboard Cite

show abstract

“…Arthritis Inflammatory arthritis occurs in approximately 4% of patients treated with ICIs and most commonly presents as a symmetrical polyarthritis resembling rheumatoid arthritis 77. Other presentations include polymyalgia rheumatica and oligoarthritis with or without tenosynovitis 77787980. Rheumatoid factor and anti-citrullinated peptide antibodies occur in a minority of patients 7981.…”

Section: Clinical Presentation Of Checkpoint Inhibitor Associated Autmentioning

confidence: 99%

Autoimmune complications of immunotherapy: pathophysiology and management

Chan

Bass

2020

BMJ

100

View full text Add to dashboard Cite

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that target inhibitory molecules, such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1), or its ligand, programmed cell death protein ligand 1 (PD-L1), and lead to immune activation in the tumor micro-environment. ICIs can induce durable treatment responses in patients with advanced cancers, but they are commonly associated with immune related adverse events (irAEs) such as rash, colitis, hepatitis, pneumonitis, and endocrine and musculoskeletal disorders. Almost all patients experience some form of irAE, but high grade irAEs occur in approximately half of those on combination therapy (eg, anti-CTLA-4 plus anti-PD-1), and up to one quarter receiving ICI monotherapy. Fatal irAEs occur in approximately 1.2% of patients on CTLA-4 blockade and 0.4% of patients receiving PD-1 or PD-L1 blockade, and case fatality rates are highest for myocarditis and myositis. IrAEs typically occur in the first three months after ICI initiation, but can occur as early as one day after the first dose to years after ICI initiation. The mainstay of treatment is with corticosteroids, but tumor necrosis factor inhibitors are commonly used for refractory irAEs. Although ICIs are generally discontinued when high grade irAEs occur, ICI discontinuation alone is rarely adequate to resolve irAEs. Consensus guidelines have been published to help guide management, but will likely be modified as our understanding of irAEs grows.

show abstract

“…A prospective study of 210 patients [12] and a large retrospective study in Mayo clinic [26] provide data that indicate a somewhat lower prevalence of the syndrome, below 1%. Calabrese et al collected 49 reported cases of PMR-like syndrome in patients on ICI therapy, analyzing data from three major rheumatology centers from USA and Europe along with a systematic review of the literature [32]. It is noteworthy that 25% of the cases did not fulfill the preliminary 2012 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) criteria for PMR.…”

Section: Polymyalgia Rheumaticamentioning

confidence: 99%

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Μελισσαρόπουλος

Klavdianou

Filippopoulou

et al. 2020

IJMS

View full text Add to dashboard Cite

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that activate the immune system, aiming at enhancing antitumor immunity. Their clinical efficacy is well-documented, but the side effects associated with their use are still under investigation. These drugs cause several immune-related adverse events (ir-AEs), some of which stand within the field of rheumatology. Herein, we present a literature review performed in an effort to evaluate all publicly available clinical data regarding rheumatic manifestations associated with ICIs. The most common musculoskeletal ir-AEs are inflammatory arthritis, polymyalgia rheumatica and myositis. Non-musculoskeletal rheumatic manifestations are less frequent, with the most prominent being sicca, vasculitides and sarcoidosis. Cases of systemic lupus erythematosus or scleroderma are extremely rare. The majority of musculoskeletal ir-AEs are of mild/moderate severity and can be managed with steroids with no need for ICI discontinuation. In severe cases, more intense immunosuppressive therapy and permanent ICI discontinuation may be employed. Oncologists should periodically screen patients receiving ICIs for new-onset inflammatory musculoskeletal complaints and seek a rheumatology consultation in cases of persisting symptoms.

show abstract

Polymyalgia rheumatica-like syndrome from checkpoint inhibitor therapy: case series and systematic review of the literature

Cited by 67 publications

References 10 publications

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

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

Autoimmune complications of immunotherapy: pathophysiology and management

Rheumatic Manifestations in Patients Treated with Immune Checkpoint Inhibitors

Contact Info

Product

Resources

About