Are Glucocorticoids Associated with Worse Survival among Rheumatoid Arthritis Patients with 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 RA patients with metastatic non‐small cell lung cancer (mNSCLC). Methods A cohort of RA patients enrolled in Medicare were identified based on: age ≥66 years, RA diagnosed prior to mNSCLC, initiated nivolumab, pembrolizumab or atezolizumab (2015‐2019, when approved only for mNSCLC). Landmark Kaplan Meier (KM) 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 RA patients with mNSCLC, mean age 75, 86.9% White, 64.7% female, 363 (46%) received glucocorticoids. Among users, median [IQR] average prednisone‐equivalents was 6.59 mg/d [IQR: 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 [HR 1.01 95%CI [0.93, 1.10]. Conclusion Glucocorticoids, at the dosages used to treat ICI‐treated RA patients with mNSCLC, had a negligible effect on survival in the 91 days after ICI initiation.