A new study has found that patients with metastatic non–small cell lung cancer (mNSCLC) and pre-existing rheumatoid arthritis (RA) have similar overall survival (OS) to those without RA when treated with immune checkpoint inhibitors (ICIs).
Researchers conducted a retrospective cohort study using Medicare claims data from patients aged 66 and older who began treatment with nivolumab, pembrolizumab or atezolizumab between March 2015 and April 2019. The study included 2,732 patients in total, with 790 having RA and 1,942 without the condition.
Patients with RA were more likely to be female and had more comorbidities. They were also more likely to be using steroids before starting ICI treatment, although use of dexamethasone, a steroid typically prescribed for cancer palliation, was similar between the groups.
Despite these baseline differences, survival outcomes did not significantly differ. Kaplan-Meier analysis and adjusted Cox models showed no meaningful difference in OS between patients with or without RA. The adjusted hazard ratio for death in RA patients was 0.92 [95% CI: 0.78-1.09].
Factors associated with worse OS included male sex, higher comorbidity burden and higher steroid use prior to treatment. However, in a sensitivity analysis excluding patients taking dexamethasone, steroid use was no longer linked to poorer outcomes.
The findings suggest that RA should not be viewed as a barrier to ICI therapy in older patients with mNSCLC, as it does not appear to adversely affect survival.
Reference
Jannat-Khah DP et al. Survival in immune checkpoint inhibitor–treated patients with rheumatoid arthritis and non–small cell lung cancer: an observational cohort study. Arthritis Care and Research. 2025;doi.org/10.1002/acr.25561.
