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Rheumatic and Musculoskeletal Immune‐Related Adverse Events Due to Immune Checkpoint Inhibitors: A Systematic Review of the Literature
Author(s) -
Cappelli Laura C.,
Gutierrez Anna Kristina,
Bingham Clifton O.,
Shah Ami A.
Publication year - 2017
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23177
Subject(s) - medicine , myalgia , myositis , vasculitis , adverse effect , clinical trial , arthritis , observational study , dermatology , disease
Objective Immune checkpoint inhibitors ( ICI s) are improving prognoses in advanced stage cancers, but they also lead to immune‐related adverse events ( IRAE s). IRAE s targeting many organ systems have been reported, but musculoskeletal and rheumatic IRAE s have not been well‐characterized. We systematically reviewed published literature on musculoskeletal and rheumatic IRAE s to better understand prevalence and clinical characteristics. Methods Medline and CENTRAL databases were searched for articles reporting rheumatic and musculoskeletal IRAE s secondary to ICI treatment. After screening abstracts and full texts in duplicate, clinical features, prevalence, and treatment data were extracted and summarized. Results A total of 1,725 unique abstracts were screened; 231 contained original data and were about ICI s and went to full‐text screening. Fifty‐two of these contained information about musculoskeletal or rheumatic IRAE s or about treatment with ICI s in preexisting autoimmune disease. Of these, 33 were clinical trials, 3 were observational studies, and 16 were case reports or series. Arthralgia prevalence in clinical trials ranged 1–43%, and myalgia was reported in 2–20%. Arthritis was reported in 5 of 33 clinical trials, and vasculitis was reported in only 2. One observational study and 3 case reports described patients with preexisting autoimmune disease treated with ICI s. Case reports included development of inflammatory arthritis, vasculitis, myositis, and lupus nephritis. Conclusion Arthralgia and myalgia have been reported commonly in patients treated with ICI s. The prevalence of rheumatic IRAE s such as inflammatory arthritis, vasculitis, and sicca syndrome is less clear from current evidence. There is limited observational and case‐level evidence describing ICI use in patients with preexisting autoimmune disease.