Rapid arthritis control in ICI-IA patients receiving biologic DMARD than MTX: Expert findings!

According to recent research published in the Annals of Rheumatic Diseases, patients with immune checkpoint inhibitor-associated inflammatory arthritis (ICI-IA) who are treated with biologic disease-modifying antirheumatic drugs (DMARDs) experience faster cancer progression compared to those treated with methotrexate. However, the use of biologic DMARDs also leads to quicker management of arthritis symptoms.

The retrospective observational study conducted by Dr. Bass and colleagues compared the effects of various medication classes in patients with immune checkpoint inhibitor-associated inflammatory arthritis (ICI-IA). Among the 147 patients, TNFi was administered to 22%, IL6Ri to 29%, and MTX to 49% for the treatment of ICI-IA. The study findings indicated that the time to cancer progression was significantly shorter for TNFi compared to MTX (hazard ratio [HR] 3.27, P=0.019). The HR for IL6Ri was 2.37 (P=0.055). TNFi demonstrated a shorter time to achieve arthritis control compared to MTX (HR 1.91, p=0.032), while IL6Ri exhibited a longer time to control the condition (HR 1.66, p=0.089). Subset analysis conducted in melanoma patients produced comparable results concerning cancer progression and arthritis management.

A 2020 study compared the real-world experiences of using triple therapy (MTX, sulfasalazine, and hydroxychloroquine) to combination therapy (TNFi and MTX) in RA patients. The percentage of biologics-naive patients who attained low disease activity at 6 months was significantly higher in the TNFi/MTX therapy group (49.2%) compared to the triple therapy group (33.3%). Additionally, the mean change in Clinical Disease Activity Index scores was also significantly higher in the TNFi/MTX treatment group (-9.3 units) compared to the triple therapy group (-5.5 units). In the patients who had been exposed to biologics, the TNFi/MTX therapy showed a numerical superiority over triple therapy, but this difference did not reach statistical significance.

The recent study findings suggest that TNFi may offer benefits in terms of faster arthritis control and delayed cancer progression in patients with ICI-IA. However, the potential implications of IL6Ri warrant further investigation. Overall, this study contributes valuable insights into the management of ICI-IA and highlights the importance of personalized treatment approaches in this patient population.


  1. Bass AR, Abdel-Wahab N, Reid PD, Sparks JA, Calabrese C, Jannat-Khah DP, Ghosh N, Rajesh D, Aude CA, Gedmintas L, MacFarlane L. Comparative safety and effectiveness of TNF inhibitors, IL6 inhibitors and methotrexate for the treatment of immune checkpoint inhibitor-associated arthritis. Annals of the rheumatic diseases. 2023 Jul 1;82(7):920-6.
  2. Curtis JR, Palmer JL, Reed GW, Greenberg J, Pappas DA, Harrold LR, Kremer JM. Real‐world outcomes associated with methotrexate, sulfasalazine, and hydroxychloroquine triple therapy versus tumor necrosis factor inhibitor/methotrexate combination therapy in patients with rheumatoid arthritis. Arthritis Care & Research. 2021 Aug;73(8):1114-24.