THU0584 RHEUMATOLOGICAL IMMUNE-RELATED ADVERSE EVENTS ASSOCIADTED WITH IMMUNOTHERAPY IN SOLID ORGAN TUMOR. STUDY OF 102 CASES FROM A REFERRAL SINGLE CENTER FOR LAST 4 YEARS
Authors: Lara Sánchez Bilbao, Iñigo González-Mazón, Rosalía Demetrio-Pablo, José Luis Martín-Varillas, Marina Delgado Ruiz, Isabel Bernat Piña, Belén Atienza-Mateo, Monica Calderón-Goercke, D. Prieto-Peña, Almudena García Castaño, Miguel A González-Gay, Ricardo Blanco
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Immune checkpoint blockade therapy (ICBT) currently is one of the most used therapies against cancer. The activation of the immune system can lead to different immune-related adverse events (irAEs), being the rheumatological side effects among the most common. <h3>Objectives</h3> Our aim was to assess the rheumatological irAEs in patients who received immunotherapy. <h3>Methods</h3> We set up an observational study of patients treated with Nivolumab and Pembrolizumab (anti-PD1), Atezolizumab (anti-PD-L1) and Ipilimumab (antiCTLA-4) for solid organ tumors. All these patients were followed in a single reference University Hospital from March-2015 up to December-2018. The main outcome was to determinate the incidence of rheumatological irAEs. <h3>Results</h3> We studied 102 patients (63♂/39♀) with a mean age of 60.6±9.7 with different solid organ tumors. Only 7 patients (6.8%) had a previous diagnosis of an immune-mediated disease: psoriasis (n=2), psoriatic arthritis (1), systemic lupus erythematosus (1), spondyloarthitis (1), rheumatoid arthritis (1) and skin lupus (1). Rheumatological side effects were observed in 15 patients (14.7%): inflammatory arthralgia (8), arthritis (6), myositis (2) and aortitis (1). The time of appearance of the rheumatological irAEs was of 6.36 months (±5.81). From the 7 patients with previous diagnosis of an immune-mediated disease, only 1 patient with psoriasis suffered a worsening of skin symptoms and another one with psoriatic arthritis had a monoarthritis episode. Among the 14 patients who suffered from arthralgia/arthritis, the most frequent pattern was oligoarticular (40%), followed by poly (30%) and monoarticular (30%). The most affected joint was the knee (n=4), followed by wrist (3), hands (3), ankle (2), shoulder (2) and foot (1). Apart from the articular disease, 2 patients suffered from myositis in lower limbs, with weakness of legs and arthralgia in their knees. A patient was diagnosed of aortitis through a PET, although the patient did not have any symptom. Immunology tests with RF, ACCP and ANA were done in 8 out of the 15 patients with musculoskeletal irAEs, being negative in all cases. Interviewing 40 of the patients who received ICBT, 7 of them (17.5%) referred xerophthalmia. 6 of them (15%) had a positive Schrimer test, and 3 (7.5%) had a reduced tear break-up time. None patient met Sjögren criteria. In 6 out of the 15 patients with rheumatological irAEs (all of them with arthralgia/arthritis) the ICBT was removed, temporary in all cases, and could be reintroduced after a mean of 33 ± 18.9 days. 6 patients were treated with NSAIDs and 5 with oral prednisone (2 of them also required intra-articular corticoids). <h3>Conclusion</h3> Rheumatological irAEs are common in clinical practice. Arthralgia-Arthritis and dry-syndrome are the most frequent adverse events. <h3>Disclosure of Interests</h3> Lara Sánchez Bilbao: None declared, Iñigo González-Mazón: None declared, Rosalía Demetrio-Pablo: None declared, José Luis Martín-Varillas: None declared, Marina Delgado Ruiz: None declared, Isabel Bernat Piña: None declared, Belén Atienza-Mateo: None declared, Monica Calderón-Goercke: None declared, D. Prieto-Peña: None declared, Almudena García Castaño: None declared, Miguel A González-Gay Grant/research support from: Prof. MA Gonzalez-Gay received grants/research supports from Abbvie, MSD, Jansen and Roche., Speakers bureau: Consultation fees/participation in company sponsored speaker's bureau from Pfizer, Lilly, Sobi, Celgene, Novartis, Roche and Sanofi., Ricardo Blanco Grant/research support from: Abbvie, MSD, and Roche, Consultant for: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen <b>DOI</b>: 10.1136/annrheumdis-2019-eular.7386