Arthralgia in patients with cancer receiving immune checkpoint inhibitors: a systematic review and meta-analysis

Background: Although immune checkpoint inhibitors (ICIs) are widely used for patients with cancer, evidence of the impact of ICIs on the incidence of arthralgia remains limited. Objective: To evaluate the impact of ICIs on arthralgia incidences in patients with cancer. Methods: We performed a systematic review to identify phase 3 randomized control trials (RCTs) evaluating ICIs in patients with cancer and reporting the incidence of arthralgia. We performed a meta-analysis to pool odds ratios (ORs) of any grade and grade 3–5 arthralgia. Results: Forty RCTs (n = 26,610) were included. The incidence of any-grade and grade 3–5 treatment-related arthralgia was 12.0% (n = 1,125/9,395) and 0.54% (n = 47/8,723). The addition of an ICI to systemic therapy, such as chemotherapy, significantly increased any-grade (OR 1.32, 95% CI: 1.13–1.54, p = 0.001) and grade 3–5 arthralgia (OR 1.78, 95% CI: 1.08–2.94, p = 0.02) with low heterogeneity among ICI subtype subgroups (I² = 0%). ICI monotherapy was associated with higher incidences of arthralgia than non-taxane (OR 6.83, 95% CI: 3.05–15.30, p < 0.001) but not than taxane chemotherapy (OR 0.74, 95% CI: 0.44–1.24, p = 0.25). Conclusions: These results could guide oncologists to assess arthralgia in patients receiving ICIs.