Rheumatology

Immune-related adverse events

Questions discussed in this category

How would you approach management of a patient with checkpoint inhibitor induced psoriatic arthritis?

Pt with active skin and joint disease. Previously on Cemiplimab (PD-1) for squamous cell carcinoma of the skin. Do you avoid traditional DMARDs due to...

1 Answer available

Would you stop azathioprine in a patient with ANCA vasculitis who has been in long term remission on azathioprine, but has a new diagnosis of lung cancer requiring initiation of immunotherapy?

2 Answers available

Is it safe to treat checkpoint inhibitor-induced arthritis with methotrexate or biologics?

1 Answer available

What is the appropriate management of severe myalgia during atezolizumab infusion?

1 Answer available

Are there any risk factors for IO induced rhabdomyolysis and how do you approach and manage it?

2 Answers available

Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?

6 Answers available

Do you initiate management of new onset diabetes in a patient on immunotherapy or refer immediately to endocrinology given the risk of rapid worsening?

1 Answer available

Are there known biomarkers predictive of IRAEs?

3 Answers available

How do you discern whether elevated liver enzymes are from immunotherapy versus chemotherapy when a patient is on combination chemo/immunotherapy?

2 Answers available

Is IL-6 inhibition an option in patients who are going to be rechallenged with checkpoint inhibitors after previously developing ICI-mediated temporal arteritis?

Would the checkpoint inhibitor still work if blocking only that portion of the inflammatory cascade as opposed to more global blockade with steroids?

2 Answers available

How do you manage steroid-refractory immune checkpoint inhibitor induced pneumonitis?

4 Answers available

Can you continue checkpoint inhibitor therapy in the setting of severe cutaneous irAE while concurrently treating the cutaneous reaction?

2 Answers available

What is your preferred steroid sparing therapy in a patient experiencing a severe checkpoint inhibitor toxicity and not responding to high dose IV steroids?

2 Answers available

How would you approach the treatment of checkpoint-inhibitor-mediated temporal arteritis?

Is there role for IVIG? Would you alter the dose or time course of steroid therapy?

2 Answers available

How do you manage psoriatic arthritis in patients who are planning to start treatment with checkpoint inhibitors for underlying malignancy?

2 Answers available

What are your recommendations for a patient with metastatic non-mutated lung adenocarcinoma who previously had headaches responsive to prednisone but with negative temporal artery biopsy for GCA?

For medical oncologists, would you offer a PD-1/L1 inhibitor? For other subspecialties, how would you counsel the oncologist regarding the risk of usi...

1 Answer available

What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?

1 Answer available

How would you approach evaluation and treatment of a patient on pembrolizumab therapy who presents with symmetric, proximal, upper extremity and lower extremity painful weakness without an elevated CK?

1 Answer available

When a patient with a preexisting rheumatic disease and on immunotherapy begins to flare, how do you decide if this is an underlying rheumatic disease activity versus an immunotherapy related adverse event?

How do you decide if it may be safe to continue immunotherapy?

1 Answer available

Is your approach to managing immune related adverse events altered at all in light of COVID-19?

2 Answers available

How do you approach further treatment of patients who develop grade 2-3 immune colitis from nivolumab/ipilimumab prior to completion of the 4 ipilimumab doses?

Do you re-challenge with nivolumab alone, change from nivo 1/ipi 3 to nivo 3/ipi 1 upon re-challenge, or stop immunotherapy altogether if grade 3?&nbs...

1 Answer available

Before re-challenging a patient with ICI after grade 1-2 pneumonitis, do you re-image to confirm resolution of pneumonitis?

1 Answer available

Would the need for infliximab/MTX/nonsteroidals to control initial irAE affect your decision to rechallenge these patients with ICI?

1 Answer available

How do you identify immunotherapy-related pneumonitis vs. radiation pneumonitis in a patient status post chemoradiation receiving consolidation immunotherapy?

Is IO related pneumonitis in the radiation field or more diffuse?

1 Answer available

Papers discussed in this category

Radiographics : a review publication of the Radiological Society of North America, Inc, 2004

Effects of radiation therapy on the lung: radiologic appearances and differential diagnosis.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-03

Pneumonitis in Patients Treated With Anti-Programmed Death-1/Programmed Death Ligand 1 Therapy.

The New England journal of medicine, 2015-07-16

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-06-10

Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline.

J Immunother Cancer, 2019 Aug 22

Concurrent therapy with immune checkpoint inhibitors and TNFα blockade in patients with gastrointestinal immune-related adverse events.

Cancer management and research, 2017

Clinical features, diagnostic challenges, and management strategies in checkpoint inhibitor-related pneumonitis.

Lancet Oncol., 2020 Mar 03

Risk of COVID-19 for patients with cancer.

Lancet, 2020 Feb 07

Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury.

Ann. Rheum. Dis., 2019 Sep 20

Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation.

Journal for immunotherapy of cancer, 2017-11-21

Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group.

J Immunother Cancer, 2021 Feb

Success and failure of additional immune modulators in steroid-refractory/resistant pneumonitis related to immune checkpoint blockade.

J Natl Compr Canc Netw,

NCCN Guidelines Insights: Management of Immunotherapy-Related Toxicities, Version 1.2020.

Ann Oncol,

Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

J Immunother Cancer,

Steroid-refractory PD-(L)1 pneumonitis: incidence, clinical features, treatment, and outcomes.

J Immunother Cancer,

Real-world insights on preferred treatments for steroid-refractory immune checkpoint inhibitor-induced pneumonitis.

J Clin Oncol, 2021 Dec 20

Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update.

J Natl Compr Canc Netw,

Management of Immunotherapy-Related Toxicities, Version 1.2022, NCCN Clinical Practice Guidelines in Oncology.

Arthritis Rheumatol, 2021 Apr 01

Inflammatory Myositis in Cancer Patients Receiving Immune Checkpoint Inhibitors.

Annals of internal medicine, 2018-01-16

Use of Immune Checkpoint Inhibitors in the Treatment of Patients With Cancer and Preexisting Autoimmune Disease: A Systematic Review.

J Immunother Cancer,

Combination anti-PD1 and ipilimumab therapy in patients with advanced melanoma and pre-existing autoimmune disorders.

Eur J Cancer, 2021 Sep 15

Interleukin-6 blockade for prophylaxis and management of immune-related adverse events in cancer immunotherapy.

Thorac Cancer, 2020 Feb 11

The role of IL-6 in immunotherapy of non-small cell lung cancer (NSCLC) with immune-related adverse events (irAEs).

J Immunother Cancer,

Rechallenge patients with immune checkpoint inhibitors following severe immune-related adverse events: review of the literature and suggested prophylactic strategy.

Future Sci OA, 2020 Aug 03

A retrospective analysis of eosinophilia as a predictive marker of response and toxicity to cancer immunotherapy.

Cancer Treat Res Commun, 2022 Jul 01

Absolute eosinophil count predicts clinical outcomes and toxicity in non-small cell lung cancer patients treated with immunotherapy.

Trends Immunol, 2021 Mar 10

Predicting and Preventing Immune Checkpoint Inhibitor Toxicity: Targeting Cytokines.

Gastroenterology, 1993-06

Hepatoprotective properties of ursodeoxycholic acid.

Gastroenterology, 1991 Jul

Evidence for a direct hepatoprotective action of ursodeoxycholic acid in primary human hepatocytes.

Z Naturforsch C J Biosci, 2002 Mar-Apr

Prophylactic effect of aqueous propolis extract against acute experimental hepatotoxicity in vivo.

Immunopharmacol Immunotoxicol, 2003 Nov

Hepatoprotective effect of baicalin, a major flavone from Scutellaria radix, on acetaminophen-induced liver injury in mice.

Exp Toxicol Pathol, 2002 Feb

Acetaminophen hepatotoxicity and mechanisms of its protection by N-acetylcysteine: a study of Hep3B cells.

Biochem Biophys Res Commun, 1999 Sep 24

Ursodeoxycholic acid protects hepatocytes against oxidative injury via induction of antioxidants.

Ital J Gastroenterol Hepatol, 1998 Dec

Amantadine hydrochloride decreases serum ALT activity without effects on serum HCV-RNA in chronic hepatitis C patients.

Chem Biol Interact, 2001 Dec 21

Vitamin E succinate protects hepatocytes against the toxic effect of reactive oxygen species generated at mitochondrial complexes I and III by alkylating agents.

Journal of immunotherapy (Hagerstown, Md. : 1997), 2018-05

PD-1 Inhibitor-associated Myopathies: Emerging Immune-mediated Myopathies.

Neurology, 2019 Mar 08

Neuromuscular adverse events associated with anti-PD-1 monoclonal antibodies: Systematic review.

Front Immunol, 2022 Aug 22

Neuromuscular junction dysfunctions due to immune checkpoint inhibitors therapy: An analysis of FAERS data in the past 15 years.

J Immunother Cancer, 2021 Jun

Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events.

Ann Oncol, 2022 Oct 18

Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2015-05

Risk of lymphoma in patients with inflammatory bowel disease treated with azathioprine and 6-mercaptopurine: a meta-analysis.

J Immunother Cancer, 2021 Jul

Timing of steroid initiation and response rates to immune checkpoint inhibitors in metastatic cancer.

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 2016 Jul 07

Azathioprine and Risk of Skin Cancer in Organ Transplant Recipients: Systematic Review and Meta-Analysis.

Arthritis & rheumatology (Hoboken, N.J.), 2019 Oct 21

Safety and Efficacy of Immune Checkpoint Inhibitors in Patients With Cancer and Preexisting Autoimmune Disease: A Nationwide, Multicenter Cohort Study.

European journal of cancer (Oxford, England : 1990), 2023 Dec 28

Effects of an immunosuppressive therapy on the efficacy of immune checkpoint inhibition in metastatic melanoma - An analysis of the prospective skin cancer registry ADOREG.

Arthritis and rheumatism, 2006 Mar

Association of chronic inflammation, not its treatment, with increased lymphoma risk in rheumatoid arthritis.

Rheumatology

Immune-related adverse events

Questions discussed in this category

Papers discussed in this category

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