PT  - JOURNAL ARTICLE
AU  - Bass, Anne R
AU  - Abdel-Wahab, Noha
AU  - Reid, Pankti D
AU  - Sparks, Jeffrey A
AU  - Calabrese, Cassandra
AU  - Jannat-Khah, Deanna P
AU  - Ghosh, Nilasha
AU  - Rajesh, Divya
AU  - Aude, Carlos Andres
AU  - Gedmintas, Lydia
AU  - MacFarlane, Lindsey
AU  - Arabelovic, Senada
AU  - Falohun, Adewunmi
AU  - Mushtaq, Komal
AU  - Haj, Farah Al
AU  - Diab, Adi
AU  - Shah, Ami A
AU  - Bingham, Clifton O
AU  - Chan, Karmela Kim
AU  - Cappelli, Laura C
TI  - Comparative safety and effectiveness of TNF inhibitors, IL6 inhibitors and methotrexate for the treatment of immune checkpoint inhibitor-associated arthritis
AID  - 10.1136/ard-2023-223885
DP  - 2023 Jul 01
TA  - Annals of the Rheumatic Diseases
PG  - 920--926
VI  - 82
IP  - 7
4099  - http://ard.bmj.com/content/82/7/920.short
4100  - http://ard.bmj.com/content/82/7/920.full
SO  - Ann Rheum Dis2023 Jul 01; 82
AB  - Objectives To compare the safety and effectiveness of biologic and conventional disease-modifying antirheumatic drugs (DMARDs) for immune checkpoint inhibitor-associated inflammatory arthritis (ICI-IA).Methods The retrospective multicentre observational study included patients with a diagnosis of ICI-IA treated with a tumour necrosis factor inhibitor (TNFi), interleukin-6 receptor inhibitor (IL6Ri) and/or methotrexate (MTX); patients with pre-existing autoimmune disease were excluded. The primary outcome was time to cancer progression from ICI initiation; the secondary outcome was time to arthritis control from DMARD initiation. Cox proportional hazard models were used to compare medication groups, adjusting for confounders.Results 147 patients were included (mean age 60.3 (SD 11.9) years, 66 (45%) women). ICI-IA treatment was TNFi in 33 (22%), IL6Ri 42 (29%) and MTX 72 (49%). After adjustment for time from ICI initiation to DMARD initiation, time to cancer progression was significantly shorter for TNFi compared with MTX (HR 3.27 (95% CI 1.21 to 8.84, p=0.019)) while the result for IL6Ri was HR 2.37 (95% CI 0.94 to 5.98, p=0.055). Time to arthritis control was faster for TNFi compared with MTX (HR 1.91 (95% CI 1.06 to 3.45, p=0.032)) while the result for IL6Ri was HR 1.66 (95% CI 0.93 to 2.97, p=0.089). A subset analysis in patients with melanoma gave similar results for both cancer progression and arthritis control.Conclusion The treatment of ICI-IA with a biologic DMARD is associated with more rapid arthritis control than with MTX, but may be associated with a shorter time to cancer progression.No data are available. All data relevant to the study are included in the article or uploaded as an online supplemental information.