Tocilizumab in immune checkpoint inhibitor-associated arthritis

The TAPIR study recently published on Annals of Oncology shows that tocilizumab can be effective in treating immune checkpoint inhibitor-associated arthritis (ICI-AR) and can prevent relapse and symptoms after rechallenge.

The study involved 26 patients with ICI-AR to evaluate tocilizumab efficacy in treating this immune-related adverse event and to verify if it could be effective as secondary prophylaxis during ICI rechallenge; patients received low dose prednisone weekly for six weeks and tocilizumab  8 mg/kg biweekly; the 11 patients undergoing ICI rechallenge were treated with or without the addition of tocilizumab. All patients treated with tocilizumab for ICI-AR achieved an ACR70 response rate, defined as greater than 70% improvement, at 10 weeks;  81% of these  patients achieved steroid-free remission after 24 weeks on tocilizumab, highlighting its role in accelerating corticosteroid tapering. Data from rechallenge group show that tocilizumab is effective secondary prophylaxis after ICI rechallenge, preventing significant arthritis flares and corticosteroid use: tocilizumab prophylaxis reduces median time to ICI rechallenge by 47.5 days and extends uninterrupted ICI therapy duration by 93 days, with no negative impact on cytokines linked to oncologic response. As authors conclude, «This study suggests that tocilizumab is a viable strategy for both the treatment and prevention of ICI-AR upon ICI rechallenge. This dual efficacy of tocilizumab could significantly change the therapeutic  landscape for patients undergoing ICI therapy who are at risk of, or have experienced, ICI-AR. By facilitating the broader use of ICIs in cancer patients, tocilizumab could ensure that a greater number of patients benefit from potent immunotherapy potentially improving patient outcomes by maintaining uninterrupted and effective ICI treatment».