Immune checkpoint inhibitors in patients with rheumatoid arthritis and melanoma: a study using real world data

The National Institute of Arthritis and Musculoskeletal and Skin Diseases awarded The Hospital For Special Surgery Fund, Inc. (HSS Foundation) $129,330 on June 15, 2026, under the Arthritis, Musculoskeletal and Skin Diseases Research program (CFDA 93.846) to support Dr. Jannat-Khah's K01 career development study investigating immune checkpoint inhibitor (ICI) treatment outcomes in patients with rheumatoid arthritis and melanoma using real-world data.

The award funds research exploring the effect of ICI treatment in autoimmune disease patients with cancer. While ICIs represent a novel and effective cancer treatment, some patients develop flares of existing autoimmune disease and immune-related adverse events (IRAEs). The study uses Komodo HealthMap, a real-world dataset, to investigate overall survival and hospitalization rates in ICI-treated rheumatoid arthritis and non-rheumatoid arthritis melanoma patients. The research also examines immunomodulatory treatment with glucocorticoids and disease-modifying antirheumatic drugs (DMARDs) and their effects on overall survival for ICI-treated rheumatoid arthritis cancer patients. Dr. Jannat-Khah's preliminary findings indicate that ICI-treated rheumatoid arthritis patients show no difference in overall survival compared to non-rheumatoid arthritis patients with metastatic non-small cell lung cancer after adjusting for steroid use, and the team has developed an algorithm to identify ICI-associated inflammatory arthritis in large real-world datasets.

Performance occurs at HSS Foundation in New York, New York, with a period of performance extending through May 31, 2031.

Abstract

Background: this K01 proposal is designed for DR. Jannat-khah to become an independent, R01 funded, investigator focused on exploring the effect of immune checkpoint inhibitor (ICI) treatment in autoimmune disease (aid) patients with cancer. Icis are a novel and effective cancer treatment; however, some patients develop flares of their existing aid and/or immune related adverse events (iraes) from ICI treatment. Iraes can occur in almost any part of the body and range in severity. Little is known about iraes among patients with pre- existing autoimmune disease as these patients were excluded from clinical trials for icis. Among ICI treated rheumatoid arthritis (RA) patients, immunomodulatory treatment with glucocorticoids or disease modifying antirheumatic drugs (dmards) might be needed to treat RA flares and/or immune related adverse events (iraes). Published results provide conflicting evidence that ICI treated RA cancer patients have worse overall survival (OS) and increased hospitalizations due to ICI treatment. Additionally, there is insufficient data on glucocorticoids and dmards treatment and their effect on OS for ICI treated RA cancer patients. Preliminary data: preliminary data by DR. Jannat-khah and her mentors, found ICI treated RA patients have no difference in OS compared to non-RA patients with metastatic non-small lung cancer (nsclc) after adjusting for steroid use prior to ICI initiation in medicare data. After ICI initiation, she found dexamethasone confounds the association of glucocorticoid use and OS in ICI treated RA nsclc patients. Lastly, we developed and published an algorithm to identify ICI-inflammatory arthritis (ICI-IA) for use in large real-world datasets (RWD). Methods: komodo healthmap (komodo), a RWD, will be used to investigate OS and hospitalization in ICI treated RA and non-RA melanoma patients. A target trial emulation will be performed to investigate treatment with glucocorticoids (alone) compared to combination treatment with glucocorticoids and methotrexate among ICI treated RA patients with melanoma. Lastly, the previously developed ICI-IA algorithm will be validated by comparing its performance in komodo together with a physician adjudicated registry of ICI-IA patients from hospital for special surgery. Career development: the overarching goal of this K01 is to use komodo, a RWD, and apply pharmacoepidemiologic methods to study ICI treated RA patients with melanoma. DR. Jannat-khah is an assistant scientist at hospital for special surgery and an assistant professor of epidemiology in medicine at weill cornell medical college. Under the mentorship of DR. Anne bass, a rheumatologist with expertise in treating ICI treated RA patients with cancer, and DR. Curtis, a rheumatologist and pharmacoepidemiologist with RWD experience; DR. Jannat-khah will perform the proposed research. Lastly, DR. Jannat-khah will participate in formal coursework to bolster her knowledge of statistical methods, pharmacoepidemiology, cancer immunology, and immunotherapy.