Oral glucocorticoid treatment for checkpoint inhibitor-associated inflammatory arthritis does not affect cancer progression-free survival: a RADIOS Registry study.

Abstract

Glucocorticoids are the first-line treatment for immune checkpoint inhibitor-associated inflammatory arthritis (ICI-IA). However, glucocorticoids may negatively impact cancer progression-free survival (PFS). We investigated the association between glucocorticoids and PFS among patients with cancer with ICI-IA. Data from the prospective multicentre rheumatic adverse events due to Immunotherapy Observational Study registry were used. Kaplan-Meier plots and multivariable Cox regression models (time-varying and landmark) assessed glucocorticoid dose and its association with PFS. Participants who progressed before glucocorticoid initiation were excluded from the landmark analysis. Participants with ICI-IA (N = 269) had a mean age of 64.85 years (SD: 12.87), 48.3% were female, 87% were White, 32% had melanoma, and most were stage IV (56.4%). In the first month of treatment, the median glucocorticoid dose (prednisone equivalent) was 13 mg daily and 7.8% of participants received an immunomodulatory disease-modifying antirheumatic drug. Cancer progression occurred in 67 participants (24.9%). In a time-varying Cox model, glucocorticoids were not associated with PFS (adjusted hazard ratio [aHR]: 2.64 [95% CI: 0.36-19.61]). Glucocorticoid doses above the median compared with below the median in the first month of ICI-IA treatment were not associated with worse PFS in adjusted Cox models (aHR: 1.15 [95% CI: 0.59-2.25]). In this prospective ICI-IA cohort, low doses of glucocorticoids (median dose 13 mg [IQR: 7.5, 25] in the first month of treatment) did not adversely affect PFS.