Abstract 14600: Pre-existing Autoimmune Disease and the Risk for Cardiovascular and Non-cardiovascular Immune Mediated Adverse Events With Immune Checkpoint Inhibitors

• Published in: Circulation (New York, N.Y.) Vol. 142; no. Suppl_3 Suppl 3; p. A14600
• Main Authors: Lee, Charlotte, Drobni, Zsofia D, Zafar, Amna, Alvi, Raza M, Murphy, Sean P, Mosarla, Ramya C, Rambarat, Paula K, Hartmann, Sarah B, Gilman, Hannah K, Zubiri, Leyre, Raghu, Vineet K, Sullivan, Ryan J, Zlotoff, Daniel A, Faje, Alexander, Reynolds, Kerry L, Neilan, Tomas G
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 17-11-2020
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.142.suppl_3.14600

IntroductionThe use of immune checkpoint inhibitors (ICIs) is associated with an increase in cardiovascular events. The mechanism is likely related to immune activation and inflammation. Patients with pre-existing autoimmune disease have a baseline increased risk for cardiovascular disease and have been traditionally excluded from clinical trials of ICIs. There is limited data on the cardiovascular and non-cardiovascular safety of ICIs in these patients. MethodsThis was a retrospective study of 2845 patients treated with an ICI at the Massachusetts General Hospital. This cohort was screened by individual chart review for patients with a diagnosis of an autoimmune disease prior to ICI therapy. These autoimmune patients were compared to controls at a 1:2 ratio. Baseline characteristics and risk of cardiovascular and non-cardiovascular immune related adverse events (iRAEs) were compared. Cardiovascular events were a composite of myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), stroke, transient ischemic attack (TIA), deep venous thrombosis (DVT), pulmonary embolism (PE), or myocarditis. Results93 patients had a diagnosis of an autoimmune disease prior to ICI. These patients were more likely to be older and to have a history of coronary artery disease, heart failure, chronic kidney disease, hypertension and diabetes mellitus. There were 12 events over a median follow-up period of 300 days. There was no significant difference in composite of cardiovascular events in follow-up (13 vs. 9.1%, autoimmune vs. none, P=0.41). The individual cardiovascular event rates were as followsMI (4.3 vs. 0.5%, P=0.04), PCI (0 vs. 0.5%, P=1), CABG (0. vs. 0.5%, P=1), stroke (0 vs. 0%), TIA (0 vs. 0.5%, P=1), DVT (5.4 vs. 2.2%, P=0.17), PE (1.1 vs. 4.8%, P=0.17), and myocarditis (2.2 vs. 1.1%, P=0.60). There was an increased rate of pneumonitis (14 vs. 4%, P<0.001) and skin toxicity (16 vs. 0%, P<0.001). ConclusionsPatients with pre-existing autoimmune disease treated with an ICI had a higher baseline cardiovascular risk but did not have a significant increase in cardiovascular events in an unadjusted analysis. These patients did, however, have an increased rate of pneumonitis and skin toxicity after ICI.