Evidence map›Paper›PMID 30877325›Full record

ArticleCancer immunology, immunotherapy : CII2019

Pre-existing autoimmune disease and the risk of immune-related adverse events among patients receiving checkpoint inhibitors for cancer.

Kenneth L Kehl, Shihao Yang, Mark M Awad, Nathan Palmer, Isaac S Kohane, Deborah Schrag

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Cancer immunology, immunotherapy : CII, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 4 pooled it
5.3field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 4 syntheses or guidelines pooled it, 94 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Preexisting autoimmune disease is a risk factor for immune-related adverse events: a meta-analysis.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2021
    Pooled it
  4. Guideline
  5. Observational
  6. Review
  7. Review
  8. Article
  9. Article
  10. Article
  11. Review
  12. Article
  13. Immune Checkpoint Inhibitors and Lupus Erythematosus.Pharmaceuticals (Basel, Switzerland) · 2024
    Review
  14. Article
  15. Article
  16. Article
  17. Review
  18. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Kenneth L KehlDivision of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA. Kenneth_Kehl@dfci.harvard.edu.ORCID http://orcid.org/0000-0001-5339-9797
Shihao YangDepartment of Statistics, Harvard University, Boston, MA, USA.
Mark M AwadThoracic Oncology Program, Dana-Farber Cancer Institute, Boston, MA, USA.
Nathan PalmerDepartment of Bioinformatics, Harvard Medical School, Boston, MA, USA.
Isaac S KohaneDepartment of Bioinformatics, Harvard Medical School, Boston, MA, USA.
Deborah SchragDivision of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.
Dana-Farber Cancer Institute · USHarvard University · US

Funding

Partnerships Between Medicaid, Tumor Registries & Cancer Control ResearchersK05CA169384 · NCI · DANA-FARBER CANCER INST · PI SCHRAG, DEBORAH · 2012 to 2016
$586k
NCI NIH HHS K05 CA169384NCI NIH HHS K05CA169384
6 · The paper itself

Abstract

introductionPatients with pre-existing autoimmune diseases have been excluded from clinical trials of immune checkpoint inhibitors (ICIs) for cancer. Real-world evidence is necessary to understand ICI safety in this population.

methodsPatients treated with ICIs from 2011 to 2017 were identified using data from a large health insurer. Outcomes included time to (1) any hospitalization; (2) any hospitalization with an irAE diagnosis; and (3) outpatient corticosteroid treatment. The key exposure was pre-existing autoimmune disease, ascertained within 12 months before starting ICI treatment, and defined either by strict criteria (one inpatient or two outpatient claims at least 30 days apart) or relaxed criteria only (any claim, without meeting strict criteria).

resultsOf 4438 ICI-treated patients, pre-existing autoimmune disease was present among 179 (4%) by strict criteria, and another 283 (6%) by relaxed criteria only. In multivariable models, pre-existing autoimmune disease by strict criteria was not associated with all-cause hospitalization (HR 1.27, 95% CI 0.998-1.62), but it was associated with hospitalization with an irAE diagnosis (HR 1.81, 95% CI 1.21-2.71) and with corticosteroid treatment (HR 1.93, 95% CI 1.35-2.76). Similarly, pre-existing autoimmune disease by relaxed criteria only was not associated with all-cause hospitalization (HR 1.11, 95% CI 0.91-1.34), but was associated with hospitalization with an irAE diagnosis (HR 1.46, 95% CI 1.06-2.01) and corticosteroid treatment (HR 1.46, 95% CI 1.13-1.88).

conclusionPre-existing autoimmune disease was not associated with time to any hospitalization after initiating ICI therapy, but it was associated with a modest increase in hospitalizations with irAE diagnoses and with corticosteroid treatment.

Indexed as

Adrenal Cortex HormonesAdultAgedAged, 80 and overAntibodies, MonoclonalAutoimmune DiseasesB7-H1 AntigenCTLA-4 AntigenFemaleHospitalizationHumansImmunotherapyInsurance, HealthMaleMiddle AgedMultivariate AnalysisAdrenal Cortex HormonesAntibodies, MonoclonalB7-H1 AntigenCTLA-4 AntigenProgrammed Cell Death 1 ReceptorCheckpoint inhibitorImmune-related adverse eventImmunotherapyReal-world evidence

Identifiers

PMID30877325
PMCPMC11028270
OpenAlexW2921256116

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.