Successful use of adalimumab in immune checkpoint inhibitor-associated inflammatory arthritis

Authors:
Open Access
Publisher website
Google Scholar
Abstract
Immune checkpoints are pathways that regulate the immune response in order to maintain self-tolerance and prevent autoimmunity. Examples of such pathways are those regulated by cytotoxic T lymphocyte antigen 4 (CTLA4) and programmed death 1 (PD1). CTLA4 is a molecule expressed by activated T cells and counteracts the T-cell co-stimulatory receptor CD28, thereby inhibiting T-cell activation. PD1 is expressed on T cells and inhibits kinases that are involved in T-cell activation in the presence of its ligands PD-L1 and PD-L2. Tumour cells can use these inhibitory mechanisms to evade T-cell-mediated elimination. Checkpoint blockade by monoclonal antibodies enhances the cell-mediated response against tumour cells, and immunotherapy has proved a successful treatment option for a range of cancers. However, these therapies are associated with a wide spectrum of side effects, known as immune-related adverse events (IRAEs), thought to arise from general immunological enhancement. Limited data are available to guide the treatment of IRAEs. We present a case of inflammatory arthritis following treatment with immune checkpoint inhibitors (ICIs) ipilimumab (anti-CTLA4) and pembrolizumab (anti-PD1) in a patient with malignant melanoma.

This publication has 8 references indexed in Scilit: