Immune checkpoint inhibitors use and effects on prognosis of COVID-19 infection: a systematic review and meta-analysis

Aim: We aimed to quantify the effects of immune checkpoint inhibitors (ICIs) on the prognosis of COVID-19. Materials & methods: A meta-analysis was conducted and the hospitalization, severe disease and mortality rates were assessed. Thirteen studies comprising of 4614 cancer patients with COVID-19 were included. Results: When compared with cancer patients without prior ICI exposure, patients with prior ICI treatment exhibited a higher rate of hospitalization (odds ratio [OR] 2.0, 95% CI 1.19-3.38, p = 0.01). However, the OR of severe disease and mortality in ICI exposed cases was similar to non-ICI exposed patients (OR 1.55, 95% CI 0.69-3.51, p = 0.29; OR 1.12, 95% CI 0.85-1.48, p = 0.42, respectively). Conclusion: It is uncertain whether prior exposure to ICIs increases the risk of severe disease and death, however the observed OR suggest a higher rate of hospitalization. Lay abstract COVID-19 is an infectious disease caused by a virus which affected people worldwide in 2020. It mainly attacks the lungs and causes symptoms such as, fever, dry cough and fatigue. However, there is currently are no definite therapies for its treatment. Cancer patients are more vulnerable due to both the tumor itself and the anticancer treatment. At the same time, they are at higher risk of COVID-19 exposure due to the need for regular treatment and testing in hospitals. In this systematic review and meta-analysis we enrolled 13 studies. Firstly, we analyzed the rate of hospitalization, severe disease and death. Additionally, we studied the impact of immune checkpoint inhibitors on the outcome of cancer patients infected with COVID-19. Finally, our discussion focuses on what we can learn from the pandemic to provide guidance for clinical practice.

Automated summary

The study found that cancer patients with prior exposure to ICIs had a higher hospitalization rate compared to those without, but the rates of severe disease and mortality were similar.