Collaborative Cases: Inflammation and Malignancies

On the 2nd day of the 9th Annual Interdisciplinary Autoimmune Summit, Joseph Merola, MD, MMSc, and Adam Cheifetz, MD, opened with their session, “Collaborative Cases in IMIDs,” to discuss complicated case scenarios that touch on the complexity of inflammatory disease management.

Highlighting various case studies, Dr Merola started by discussing multicentric reticulohistiocytosis (MRH) found in one particular study. He noted that this wasn’t particularly common, even mentioning he had only come across 2 cases. It presents as a malignancy workup (paraneoplastic) that is a cause of arthritis mutilans, leading to a potential destructive inflammatory arthritis.

Continuing on, Dr Merola presented a case highlighting the use of systemic therapeutics for psoriasis and their impact on malignancy. As of this moment, the safety of those systemic therapeutics with active malignancy is unknown.

“Still, one may argue that with such a severe disease we still need to treat [the patient], and it’s not an option to not treat her,” he added.

Next, Dr Merola touched upon the topic of TNF inhibition and malignancy. He noted that, currently, present prescribing information warns against the use of anti-TNF in patients with concurrent or previous history of malignancy. However, recent data found in meta-analyses and observational and cohort studies showed that there was no significantly increased risk of systemic malignancies for anti-TNF in psoriasis.

“Still, many have concerns based on mechanism of action and have negative associations linked to nonmelanoma skin cancers/squamous cell carcinoma, melanoma reports, and lymphoma,” he stated.

Lastly, a particular topic he touched on was data showcasing the use of IL-17s with malignancy. He stressed that important considerations had to be made based on recent data. These data showcased potential anti-IL-17A exacerbation or induction of inflammatory bowel disease. Additionally, IL-17 inhibition, IL-17RA inhibition, and IL-17 knockout led to induction or exacerbation of colitis in a study that utilized mouse models. Most importantly, recent clinical trials of that looked at brodalumab and secukinumab showed that they failed to achieve primary efficacy with Crohn’s disease, worsening in some cases as opposed to placebo.

Reference
Merola J, Cheifetz A. Collaborative Cases in IMIDs. Presented at: Interdisciplinary Autoimmune Summit; April 21-24, 2022; Virtual.