Adverse impacts of immune checkpoint inhibitors

Rheumatologists need to be more aware of the potential contribution of immune checkpoint inhibitors (ICI) in patients presenting with rheumatological symptoms, the Irish Society for Rheumatology (ISR) Autumn Meeting heard from a leading US expert in the area.

The rheumatologic manifestations encountered with the increased use of ICI was explored during the final session of the meeting by Dr Laura Cappelli, Associate Professor of Medicine and Oncology, Department of Rheumatology at the John Hopkins University School of Medicine, US. Dr Cappelli’s primary research interest is inflammatory arthritis due to ICI therapy and she co-directs a research programme evaluating the rheumatologic adverse effects of cancer immunotherapy.

Rheumatologists are increasingly seeing patients with inflammatory arthritis, immune-mediated dry mouth and eyes, myositis, vasculitis and other adverse events due to ICIs, with manifestations occurring up to two years and sometimes even longer after treatment, she said.

Therefore, Dr Cappelli stressed the need for rheumatologists to be very aware of and alert to the potential impact of these drugs, and how disease can present differently from ‘traditional’ patients.

“I think rheumatologists should have a high index of suspicion if people have received these drugs within the recent past. Within our medical institution, there is a flag on the electronic record system that will let you know if a patient has had an ICI, that stays up for five years in the system,” Dr Cappelli told the Medical Independent, urging rheumatologists to collaborate with their oncology colleagues on the issue.

Meanwhile, Dr Elizabeth Price, Consultant Rheumatologist and South-West MSK Regional Lead, Great Western Hospital NHS, UK, discussed the new British Society for Rheumatology Sjogren’s disease management guideline 2024, which she led the development of.

The new guideline is an update of the previous 2016 document. It expanded recommendations in relation to children and adolescents, as well as adults, is NICE-accredited, and features updated diagnostic criteria.

Other speakers at the ISR meeting included Dr Allyson Egan, Consultant in Nephrology and Medicine at Trinity Health Kidney Centre, Tallaght University Hospital, Dublin, who discussed the use of biologics in eosinophilic granulomatosis with polyangiitis; Dr Elena Nikiphorou, Consultant Rheumatologist, King’s College Hospital, London, UK, whose talk focused on the pharmaceutical and non-pharmaceutical management of rheumatoid arthritis; and Prof Filip van den Bosch, Head-of-Clinic and Associate Professor of Rheumatology, University of Ghent, Belgium, who tackled the evolving placement of Janus kinase inhibitors in treatment paradigms.