Risk of tuberculosis in patients with cancer treated with immune checkpoint inhibitors: a nationwide observational study
Open Access
- 14 September 2021
- journal article
- research article
- Published by BMJ in Journal for ImmunoTherapy of Cancer
- Vol. 9 (9), e002960
- https://doi.org/10.1136/jitc-2021-002960
Abstract
Background While some recent studies have reported the development of tuberculosis (TB) in patients exposed to immune checkpoint inhibitors (ICIs), there is limited evidence to date. Therefore, we evaluated the risk of TB in patients with cancer exposed to ICIs using the National Health Insurance claims data in South Korea. Methods Patients with diagnostic codes for non-small cell lung cancer, urothelial carcinoma or melanoma between August 2017 and June 2019 were identified. The incidence rate and standardized incidence ratio (SIR) of TB were calculated for both the ICI exposure and non-exposure groups. The risk of TB according to ICI exposure was assessed using a multivariable Cox regression model. Results During the study period, 141 550 patients with cancer and 916 new TB cases were identified. Among the 5037 patients exposed to ICIs, 20 were diagnosed with TB at a median of 2.2 months after the ICI was initiated. The crude incidence rate of TB per 100,000 person-years was 675.8 (95% CI 412.8 to 1043.8) for the ICI exposure group and 599.1 (95% CI 560.5 to 639.6) for the non-exposure group. The SIR for TB was 8.1 (95% CI 8.0 to 8.2) in the ICI exposure group. After adjusting for potential confounding factors, ICI treatment was not significantly associated with an increased risk of TB (HR: 0.73; 95% CI 0.47 to 1.14). Conclusions While the incidence of TB in cancer patients exposed to ICIs was eightfold higher than in the general population, the risk of patients with cancer developing TB did not significantly differ according to ICI exposure.Funding Information
- Ministry of Health and Welfare (HW20C2062)
This publication has 34 references indexed in Scilit:
- Nivolumab versus Docetaxel in Advanced Squamous-Cell Non–Small-Cell Lung CancerThe New England Journal of Medicine, 2015
- Nivolumab in Previously Untreated Melanoma withoutBRAFMutationThe New England Journal of Medicine, 2015
- T Cells from Programmed Death-1 Deficient Mice Respond Poorly to Mycobacterium tuberculosis InfectionPLOS ONE, 2011
- CD4 T Cells Promote Rather than Control Tuberculosis in the Absence of PD-1–Mediated InhibitionThe Journal of Immunology, 2011
- Role Played by the Programmed Death‐1–Programmed Death Ligand Pathway during Innate Immunity againstMycobacterium tuberculosisThe Journal of Infectious Diseases, 2010
- Programmed death-1 (PD-1)–deficient mice are extraordinarily sensitive to tuberculosisProceedings of the National Academy of Sciences of the United States of America, 2010
- Programmed Death (PD)-1:PD-Ligand 1/PD-Ligand 2 Pathway Inhibits T Cell Effector Functions during Human TuberculosisThe Journal of Immunology, 2008
- Solid‐organ malignancy as a risk factor for tuberculosisRespirology, 2008
- Glucocorticoid use, other associated factors, and the risk of tuberculosisArthritis Care & Research, 2006
- Targeted Tuberculin Testing and Treatment of Latent Tuberculosis InfectionAmerican Journal of Respiratory and Critical Care Medicine, 2000