Researchers from Johns Hopkins report that some cancer immunotherapy drugs, such as Yervoy and Opdivo, could increase the risk of arthritis among some patients.
According to a case report published in the Annals of Rheumatic Diseases on June 15, a class of cancer drugs known as Immune checkpoint inhibitors (ICIs) appear to be connected to immune-related adverse events, which may manifest as inflammatory arthritis and sicca syndrome.
Johns Hopkins researchers reported on patients evaluated in the Baltimore-based medical center’s Rheumatology clinics from 2012 to 2016, who had new symptoms of arthritis after taking Yervoy or Opdivo for the treatment of solid tumors.
At least 13 patients were identified who received ICIs and developed arthritis, nine of which were diagnosed with inflammatory arthritis, four with synovitis, and four with inflammatory synovial fluid. All of the patients were treated with corticosteroids.
Only about 1.3% of patients who take the drugs appear to suffer these effects, but the use of the drugs is spreading, researchers indicated. However, they noted that if future studies confirm a connection between the drugs and an increased risk of arthritis, their numbers will likely be seen as an underestimation.
“We keep having referrals coming in from our oncologists as more patients are treated with these drugs,” Dr. Clifton Bingham, associate professor of medicine and director of Johns Hopkins Arthritis Center, said in a June 23 press release. “In particular, as more patients are treated with combinations of multiple immunotherapies, we expect the rate to go up.”
Other types of immune responses have been linked to the drugs, which strengthens the chances that the drugs can cause arthritis as well, the researchers noted. During the original clinical trials for Yervoy and Opdivo, increased risks were detected for inflammatory bowel diseases, lung inflammation, and other side effects that are considered immune-related.
The researchers raised concerns that the effects seem to be getting more severe in patients as time goes on.
“In 2015, our rheumatology clinic started getting more and more referrals from our oncology department to evaluate patients treated with immunotherapies,” study author, Dr. Laura C. Cappelli, said. “And the patients we saw had very severe, highly inflammatory arthritis. They needed even higher doses of steroids to control their symptoms compared to what is needed in other forms of inflammatory arthritis, like rheumatoid arthritis.”