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Spectrum and impact of checkpoint inhibitor-induced irAEs

Immune checkpoint inhibitors, which are used to treat many types of cancer, can cause syndromes similar to rheumatic diseases known as immune-related adverse events (irAEs). In 2020, several studies illustrated the clinical heterogeneity of rheumatic irAEs and highlighted their substantial effect on morbidity and mortality.

Key advances

  • Immune checkpoint inhibitor (ICI)-induced myositis has a high mortality rate, particularly when associated with myocarditis and myasthenia gravis, and can happen shortly after ICI initiation2.

  • Rheumatic immune-related adverse events (irAEs) of all kinds necessitate systemic immunosuppression, and for most patients in one multicentre study, tumour response did not worsen after treatment of these irAEs3.

  • Patients with inflammatory arthritis attributable to ICI therapy experience substantial emotional and functional effects, outcomes that could be improved with increased awareness, multidisciplinary care and increased social support4.

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Fig. 1: New insights into the occurrence and effects of ICI-induced irAEs.


  1. 1.

    Kostine, M., Truchetet, M. E. & Schaeverbeke, T. Clinical characteristics of rheumatic syndromes associated with checkpoint inhibitors therapy. Rheumatology 58 (Suppl. 7), vii68–vii74 (2019).

    CAS  Article  Google Scholar 

  2. 2.

    Allenbach, Y. et al. Immune checkpoint inhibitor-induced myositis, the earliest and most lethal complication among rheumatic and musculoskeletal toxicities. Autoimmun. Rev. 19, 102586 (2020).

    CAS  Article  Google Scholar 

  3. 3.

    Roberts, J. et al. Rheumatic immune-related adverse events associated with cancer immunotherapy: a nationwide multi-center cohort. Autoimmun. Rev. 19, 102595 (2020).

    CAS  Article  Google Scholar 

  4. 4.

    Cappelli, L. C., Grieb, S. M., Shah, A. A., Bingham, C. O. 3rd & Orbai, A. M. Immune checkpoint inhibitor-induced inflammatory arthritis: a qualitative study identifying unmet patient needs and care gaps. BMC Rheumatol. 4, 32 (2020).

    Article  Google Scholar 

  5. 5.

    Calabrese, L. H., Calabrese, C. & Cappelli, L. C. Rheumatic immune-related adverse events from cancer immunotherapy. Nat. Rev. Rheumatol. 14, 569–579 (2018).

    Article  Google Scholar 

  6. 6.

    Subedi, A. et al. Use of magnetic resonance imaging to identify immune checkpoint inhibitor-induced inflammatory arthritis. JAMA Netw. Open 3, e200032 (2020).

    Article  Google Scholar 

  7. 7.

    Albayda, J., Dein, E., Shah, A. A., Bingham, C. O. 3rd & Cappelli, L. Sonographic findings in inflammatory arthritis secondary to immune checkpoint inhibition: a case series. ACR Open Rheum. 1, 303–307 (2019).

    Article  Google Scholar 

  8. 8.

    Daoussis, D. et al. An MRI study of immune checkpoint inhibitor-induced musculoskeletal manifestations myofasciitis is the prominent imaging finding. Rheumatology 59, 1041–1050 (2020).

    CAS  Article  Google Scholar 

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Corresponding author

Correspondence to Laura C. Cappelli.

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Competing interests

L.C.C. and C.O.B. declare that they have received research funding from Bristol-Myers Squibb, and that L.C.C. has acted as a consultant for AbbVie.

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Cappelli, L.C., Bingham, C.O. Spectrum and impact of checkpoint inhibitor-induced irAEs. Nat Rev Rheumatol 17, 69–70 (2021).

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