A Systematic Review and Meta-analysis of Observational Studies and Uncontrolled Trials Reporting on the Use of Checkpoint Blockers in Patients with Cancer and Pre-existing Autoimmune Disease
Abstract
Background: Cancer patients with autoimmune disease have been excluded from randomized trials of immune checkpoint blockers (ICBs). We conducted a systematic review of observational studies and uncontrolled trials including cancer patients with pre-existing autoimmune disease who received ICIs. Methods: We searched 5 electronic databases through November 2023. Study selection, data collection, and quality assessment were performed independently by 2 investigators. We performed a meta-analysis to pool incidence of immune-related adverse events (irAEs), including de novo events and flares of existing autoimmune disease, hospitalizations due to irAEs, as well as deaths. Results: A total of 95 studies were included (23,897 patients with cancer and preexisting autoimmune disease). The most common cancer evaluated was lung cancer (30.7%) followed by skin cancer (15.7%). Patients with autoimmune disease were more likely to report irAEs compared to patients without autoimmune disease (relative risk 1.3, 95% CI 1.0 to 1.6). The pooled occurrence rate of any irAEs (flares or de novo) was 61% (95% CI 54% to 68%); that of flares was 36% (95% CI 30% to 43%), and that of de novo irAEs was 23% (95% CI 16% to 30%). Flares were mild (grade <3) in half of cases and more commonly reported in patients with psoriasis/psoriatic arthritis (39%), inflammatory bowel disease (37%), and rheumatoid arthritis (36%). 32% of the patients with irAEs required hospitalization and treatment of irAEs included…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 23,897 participants or records.
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