TOPLINE:

Patients with rheumatoid arthritis (RA) who received immune checkpoint inhibitors (ICIs) for cancer had no increased risk for mortality and showed no differences in cause of death compared with patients without RA.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to evaluate mortality and causes of death among US veterans from the Veterans Health Administration with and without RA who were undergoing cancer treatment with ICIs.
• They included 301 patients who had a diagnosis of RA and were treated with a disease-modifying antirheumatic drug (DMARD) or had positive laboratory markers and 2114 matched control individuals without RA; both groups (mean age, 71.2 years; 93% men) received treatment with ICIs between 2011 and 2023.
• The primary outcome was overall survival, with cause-specific mortality as the secondary outcome.
• Data on all-cause mortality and cause-specific mortality were obtained from the Veterans Affairs Death Ascertainment File and the National Death Index, respectively.
• Data regarding cancer type, exposure to different ICIs and DMARDs, and total exposure to glucocorticoids were also collected. Risk for mortality was assessed, with adjustments for various covariates.

TAKEAWAY:

• The overall utilization of outpatient clinical services was higher among patients with vs without RA (average number of visits per year, 18.0 vs 14.3; P = .002). Glucocorticoid therapy prior to ICI infusion was also more common among patients with vs without RA (94.4% vs 76.3%; P < .0001).
• No significant difference in survival was observed between patients with and without RA treated with ICIs in the Kaplan-Meier analysis (P = .267), with no significant difference in the risk for all-cause mortality.
• The most common cause of death in both groups was neoplasms, accounting for over 90% of deaths.
• Survival rates at 1 and 2 years were not significantly different between patients with non-small cell lung cancer with and without RA.

IN PRACTICE:

“These results provide critical information for rheumatology and oncology providers to consider when discussing potential risks and benefits of cancer treatment options in patients with underlying RA. While these data suggest that a diagnosis of RA alone should not prevent consideration for ICI therapy when appropriately indicated, there remains a critical need for individualized risk-benefit assessment in decision making for cancer treatment recommendations in RA patients,” the authors of the study wrote.

SOURCE:

The study was led by Madeline L. O’Sullivan, MD, Veteran Affairs Salt Lake City Health Care System and University of Utah in Salt Lake City. It was published online on November 10, 2025, in Arthritis Care & Research.

LIMITATIONS:

Specific indications for glucocorticoid prescriptions were lacking. The sample predominantly included older male veterans, which may affect generalizability to broader populations. The rates or severity of RA flares or other immune-related adverse events were not assessed. 

DISCLOSURES:

The study was supported by grants from the Center of Excellence for Suicide Prevention, the Joint Department of Veterans Affairs and Department of Defense Suicide Data Repository, and the Western Institute for Veterans Research. Two authors reported receiving support for the current study from various sources, and few other authors reported receiving grants and contracts, royalties or licenses, and/or consulting fees from various sources or serving as board members.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.