AB1216 CHECKING IN WITH IMMUNE CHECKPOINT INHIBITORS: RESULTS FROM A NEEDS ASSESSMENT SURVEY OF CANADIAN RHEUMATOLOGISTS
Authors: Ahmad Abdullah, Nancy Maltez, Marie Hudson, Aurore Fifi-Mah, Shahin Jamal
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Immune checkpoint inhibitors (ICI) have revolutionized the treatment of cancer. However, enhanced immune activation from ICI has been associated with immune-related adverse events (irAE), including autoimmune rheumatologic diseases such as inflammatory arthritis, spondyloarthritis, polymyalgia rheumatica-like syndrome and inflammatory myositis, among many others. This emerging field represents a challenge given that experience with these conditions is limited and evidence-based recommendations do not yet exist. <h3>Objectives</h3> The Canadian Research Group of Rheumatology in Immuno-Oncology (CanRIO) is an emerging network of rheumatologists interested in rheumatic irAE (rh-irAE). CanRIO undertook a needs assessment survey to understand the need for education and recommendations for the management of rh-irAE in the rheumatology community in Canada. The primary objective was to recognize the knowledge gaps, if any, and understand current patterns of practice in this newly emerging area. <h3>Methods</h3> A 25-item electronic survey was developed by the CanRIO investigators. The survey, which was available in both French and English, was distributed via electronic mail to 574 members of the Canadian Rheumatology Association (CRA). Responses were collected over a period of 14 days. Results were summarized using descriptive statistics. <h3>Results</h3> Of the 574 CRA members who were invited to participate, 83 responded (response rate of 14.5%). Half of the respondents were adult rheumatologists from academic centres and 25% from the community. Over 25% of the respondents were not familiar with ICI and irAE. Half of the respondents had not seen or managed patients with irAE, and among the remaining, the majority had seen less than 5 patients with irAE. Inflammatory arthritis was the most common rh-irAE encountered. Other rh-irAE included sicca, myositis, sarcoid and vasculitis. Prednisone and methotrexate were the most common treatment strategies. Almost half of the respondents (43.6%) had been asked for advice from oncologists regarding discontinuation of ICI for irAE, and of these, almost half (48.7%) reported that they were either ‘slightly confident’ or ‘not confident at all’ in providing advice. Over half of the respondents had not yet been asked to provide advice concerning ICI for patients with pre-existing auto-immune diseases. The vast majority (87.2%) agreed that there was a need for clinical practice guidelines for the management of rh-irAE. <h3>Conclusion</h3> The survey highlighted the important knowledge gaps in the emerging field of rh-irAE. Given the increasing use of ICI in a growing number of cancer types and stages, referrals for rh-irAE are likely to increase. There is strong rationale to develop educational programs and clinical practice guidelines to support Canadian rheumatologists who will be increasingly responsible for managing rh-irAE. <h3>Reference</h3> [1] Ye, Carrie; Jamal, Shahin; Hudson, Marie. CRAJ 2018. Volume 28, Number 3, pages 24-25. “Rheumatic Immune-related Adverse Events Associated with Immune Checkpoint Inhibitors for Cancer: Coming Soon to a Clinic Near You!” <h3>Disclosure of Interests</h3> Ahmad Abdullah: None declared, Nancy Maltez: None declared, Marie Hudson Grant/research support from: Unrestricted research funds from Bristol-Myers Squibb, Aurore Fifi-Mah Grant/research support from: Roche, Abbvie, Janssen, BMS, Speakers bureau: Roche, Abbvie, Janssen, BMS, Pfizer, Shahin Jamal Consultant for: Consultant for Abbvie, Amgen, BMS, Eli Lilly, Pfizer, Janssen, Merck, UCB