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Checkpoint Inhibitor Safety in Preexisting Autoimmune Diseases

Medscape reports on the findings of a study published in Annals of Internal Medicine showing patients with advanced melanoma and preexisting autoimmune diseases (AIDs) who were treated with immune checkpoint inhibitors (ICIs) responded well and did not suffer more grade 3 or higher immune-related adverse events than patients without an AID.

HSS rheumatologist Anne R. Bass, MD, who was not involved in the study, provided commentary on the results and methodology. “For detail, you can't look to this study," said Dr. Bass. "But for a big-picture look at 'how safe are checkpoint inhibitors,' I think it's an important one.”

Dr. Bass noted the investigators grouped certain elements together and bypassed others, including their focus on grade 3 or higher adverse events (a decision the authors recognized as a potential limitation of their research). "Understandably, they were worried about life-threatening adverse events, and that's fine," explained Dr. Bass. But for patients with arthritis who flare, their events are usually grade 2 or even grade 1 and therefore not captured or analyzed in the study. "This does not really address the risk of flare in an RA [rheumatoid arthritis] patient," she cited.

The grouping of AIDs, with a bevy of rheumatic diseases categorized as one cluster and the "other" group being particularly broad in its inclusion of "all AIDs not listed" — though only eight patients were placed into that group. That said, the researchers relied on an oncology database, not one aimed at AID or adverse events. "The numbers are so much bigger than any other study in this area that's been done," noted Dr. Bass. "It's both a strength and a weakness of this kind of database."

Read the full article at Medscape.com.