The use of immune checkpoint inhibitors is associated with a decreased likelihood of developing neurologic adverse events (NAEs) compared with other cancer medications, particularly cytotoxic chemotherapy, according to the results of a meta-analysis.
Researchers compared NAEs reported in randomized clinical trials of US Food and Drug Administration-approved immune checkpoint inhibitors with other forms of chemotherapy and with placebo. The analysis included 39 phase 2 and phase 3 trials including 23,705 patients.
The overall risk of NAEs was lower in the immune checkpoint inhibitor group (risk ratio [RR]=0.59; 95% CI, 0.45-0.77) and in the subgroup of trials that compared immune checkpoint inhibitors with chemotherapy (RR=0.22; 95% CI, 0.13-0.39). However, the researchers noted that “the heterogeneity in the comparator arm limits the interpretation of this analysis as several randomized clinical trials involved either chemotherapy in both arms or had an immunomodulator, tyrosine kinase inhibitor, or placebo in the comparator arm.”
Compared with placebo, the risk of NAEs was significantly higher with immune checkpoint inhibitors (RR=1.57; 95% CI, 1.30-1.89).
Looking at specific adverse events, risk for peripheral neuropathy (RR=0.09), dysgeusia (RR=0.42), and paresthesia (RR=0.29) was significantly lower with immune checkpoint inhibitors compared with placebo. Risk for headache was higher with immune checkpoint inhibitors (RR=1.63) compared with placebo.
“Further research is needed to understand the full spectrum of NAEs associated with the use of immune checkpoint inhibitors, especially the rarer NAEs that are not commonly registered in randomized clinical trials,” the researchers wrote.
Farooq MZ, Aqeel SB, Lingamaneni P, et al. Association of immune checkpoint inhibitors with neurologic adverse events. A systematic review and meta-analysis. JAMA Network Open. 2022;5(4):e227722.