Are Glucocorticoids Associated With Worse Survival Among Patients With Rheumatoid Arthritis and Lung Cancer Treated With Immune Checkpoint Inhibitors?

[OBJECTIVE] Glucocorticoids are commonly used for rheumatoid arthritis (RA) treatment and to palliate some malignancies, but it is unclear whether glucocorticoids attenuate the benefits of immune checkpoint inhibitor (ICI) cancer therapy. We examined the association between glucocorticoid use and survival among ICI-treated patients with RA and metastatic nonsmall cell lung cancer (mNSCLC).

[METHODS] A cohort of patients with RA enrolled in Medicare were identified based on the following: age ≥66 years, RA diagnosed before mNSCLC, and having initiated nivolumab, pembrolizumab, or atezolizumab (2015-2019, when approved only for mNSCLC). Landmark Kaplan-Meier curves and time-varying adjusted Cox models were used to examine the association between early glucocorticoid use (within 91 days after ICI initiation) and survival. Dexamethasone users were excluded from the primary analysis and included in a sensitivity analysis.

[RESULTS] We identified 663 ICI-treated patients with RA and mNSCLC, with a mean age of 75 years, 86.9% being White, 64.7% being female, and 363 (46%) receiving glucocorticoids. Among users, the median average prednisone equivalents was 6.59 mg/d (interquartile range 3.30, 12.31). In a time-varying Cox model, glucocorticoid use was not associated with survival. Additionally, in a 91-day landmark model, glucocorticoid dose was not associated with survival (hazard ratio 1.01; 95% confidence interval 0.93, 1.10).

[CONCLUSION] Glucocorticoids, at the dosages used to treat ICI-treated patients with RA and mNSCLC, had a negligible effect on survival in the 91 days after ICI initiation.