(HealthDay News) — Although patients with pre-existing autoimmune disease who receive checkpoint inhibitors (CPIs) are at risk for exacerbation of their disease, immune-related adverse events (irAEs), or both, events can often be managed without discontinuing CPIs, according to a review published online in the Annals of Internal Medicine.

Noha Abdel-Wahab, MD, PhD, from the University of Texas MD Anderson Cancer Center in Houston, and colleagues conducted a systematic review to summarize the evidence on adverse events associated with CPIs in patients with cancer and pre-existing autoimmune disease. Data were included from 123 patients identified in 49 publications.

The researchers found that 75% of the patients had exacerbations of pre-existing autoimmune disease, irAEs, or both. Patients with active and inactive disease did not differ in terms of adverse events. Fewer adverse events seemed to occur among patients receiving immunosuppressive therapy at initiation of CPI therapy than in those not receiving treatment. Most of the flares and irAEs were managed with corticosteroids; other immunosuppressive therapies were required by 16%. In more than half of the patients, adverse events improved without discontinuation of CPI therapy. Three patients died because of adverse events.

“Prospective longitudinal studies are needed to establish incidence of adverse events and evaluate risk-benefit ratios and patient preferences in this population,” the authors write.

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One author disclosed financial ties to the pharmaceutical industry.

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Abdel-Wahab N, Shah M, Lopez-Olivo MA, Suarez-Almazor ME. Use of Immune Checkpoint Inhibitors in the Treatment of Patients With Cancer and Preexisting Autoimmune Disease: A Systematic Review. Ann Intern Med. doi: 10.7326/M17-2073

Calabrese LH. Sorting Out the Complexities of Autoimmunity and Checkpoint Inhibitors: Not So Easy. Ann Intern Med. doi: 10.7326/M17-3079