Patients with Cancer and Immune Checkpoint Inhibitor-Induced Rheumatic irAEs Treated by DMARDs: The RHUMICI Single-Centre Retrospective Cohort
Abstract
Background/Objectives: Immune checkpoint inhibitors (ICIs) can lead to immune-related adverse events (irAEs), including rheumatic manifestations affecting 5–10% of treated patients. Managing rheumatic irAEs is challenging, as the use of glucocorticoids (GCs) or disease-modifying antirheumatic drugs (DMARDs) raises concerns about potentially impairing ICI antitumour efficacy. The oncological safety of DMARDs used specifically for rheumatic irAE management remains poorly characterised. Our objective was to evaluate the oncological safety profile of various rheumatic irAE treatment strategies. Methods: This single-centre retrospective observational study included 55 patients out of 104 who underwent rheumatological evaluation between July 2016 and October 2022. Patients were categorised into three groups: symptomatic treatment alone (analgesics/NSAIDs, n = 11), systemic glucocorticoids (GCs) only (n = 27), and conventional synthetic or biological disease-modifying antirheumatic drugs (csDMARDs and/or bDMARDs, n = 17). Overall survival (OS) and progression-free survival (PFS) were compared using a Kaplan–Meier analysis. Results: The three most frequent rheumatic irAE patterns were undifferentiated arthritis (n = 20), rheumatoid arthritis-like presentations (n = 14), and polymyalgia rheumatica (n = 11). Patients in the DMARD group had more severe irAEs (CTCAE grade ≥3: 30% vs. 15%, p < 0.01) and a higher baseline CRP (27.5 vs. 17.4 mg/L, p < 0.05), reflecting greater disease burden at treatment initiation. No significant difference was observed between groups for OS (p = 0.22) or PFS (p = 0.31) over a median follow-up of 34 months. Conclusions: No detrimental oncological safety signal was identified across rheumatic irAE treatment strategies, including GCs combined with csDMARDs or bDMARDs. These results support the cautious use of DMARDs as GC-sparing agents when clinically indicated, consistent with current EULAR and ESMO guidelines, and underline the need for prospective trials to optimise immunosuppressive management in ICI-treated patients.
Related
- mtDNA Activates AIM2-Mediated PANoptosis in Interstitial Macrophages to Promote Immune Checkpoint Inhibitor Pneumonitis
- A Systematic Audit of ClinicalTrials.gov: Helminth Baseline Data Collection in Checkpoint Inhibitor Trials in Parasite-Endemic Regions
- Vaccination targeting the novel endogenous tumor-associated antigen Gpr149 induces protective immunity against checkpoint inhibitor-refractory SB28 glioblastoma
- HLA profiles in immune checkpoint inhibitor-associated neuromuscular adverse events
- Efficacy and safety of immune checkpoint inhibitor plus bevacizumab-based chemotherapy in advanced or recurrent KRAS-mutant non-squamous NSCLC: the SPIRAL-STONE study
BibTeX
@article{massy2026patients,
title = {{Patients with Cancer and Immune Checkpoint Inhibitor-Induced Rheumatic irAEs Treated by DMARDs: The RHUMICI Single-Centre Retrospective Cohort}},
author = {Emmanuel Massy and Julien Seiller and Muriel Piperno and Edith Bonnelye and Denis Maillet and Stéphane Dalle and Clara Fontaine-Delaruelle and Pierre-Jean Souquet and Julien Péron and Cyrille Confavreux},
journal = {Cancers},
year = {2026},
month = jul,
doi = {10.3390/cancers18142213},
url = {https://hal.science/hal-05750697v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Patients with Cancer and Immune Checkpoint Inhibitor-Induced Rheumatic irAEs Treated by DMARDs: The RHUMICI Single-Centre Retrospective Cohort
AU - Emmanuel Massy
AU - Julien Seiller
AU - Muriel Piperno
AU - Edith Bonnelye
AU - Denis Maillet
AU - Stéphane Dalle
AU - Clara Fontaine-Delaruelle
AU - Pierre-Jean Souquet
AU - Julien Péron
AU - Cyrille Confavreux
PY - 2026
DA - 2026/07/09
JO - Cancers
DO - 10.3390/cancers18142213
UR - https://hal.science/hal-05750697v1
AB - Background/Objectives: Immune checkpoint inhibitors (ICIs) can lead to immune-related adverse events (irAEs), including rheumatic manifestations affecting 5–10% of treated patients. Managing rheumatic irAEs is challenging, as the use of glucocorticoids (GCs) or disease-modifying antirheumatic drugs (DMARDs) raises concerns about potentially impairing ICI antitumour efficacy. The oncological safety of DMARDs used specifically for rheumatic irAE management remains poorly characterised. Our objective was to evaluate the oncological safety profile of various rheumatic irAE treatment strategies. Methods: This single-centre retrospective observational study included 55 patients out of 104 who underwent rheumatological evaluation between July 2016 and October 2022. Patients were categorised into three groups: symptomatic treatment alone (analgesics/NSAIDs, n = 11), systemic glucocorticoids (GCs) only (n = 27), and conventional synthetic or biological disease-modifying antirheumatic drugs (csDMARDs and/or bDMARDs, n = 17). Overall survival (OS) and progression-free survival (PFS) were compared using a Kaplan–Meier analysis. Results: The three most frequent rheumatic irAE patterns were undifferentiated arthritis (n = 20), rheumatoid arthritis-like presentations (n = 14), and polymyalgia rheumatica (n = 11). Patients in the DMARD group had more severe irAEs (CTCAE grade ≥3: 30% vs. 15%, p < 0.01) and a higher baseline CRP (27.5 vs. 17.4 mg/L, p < 0.05), reflecting greater disease burden at treatment initiation. No significant difference was observed between groups for OS (p = 0.22) or PFS (p = 0.31) over a median follow-up of 34 months. Conclusions: No detrimental oncological safety signal was identified across rheumatic irAE treatment strategies, including GCs combined with csDMARDs or bDMARDs. These results support the cautious use of DMARDs as GC-sparing agents when clinically indicated, consistent with current EULAR and ESMO guidelines, and underline the need for prospective trials to optimise immunosuppressive management in ICI-treated patients.
SN - 2072-6694
SN - 2072-6694
ER -