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30-04-2020 | Rheumatology | News | Article

guidelinesWatch

EULAR provides guidance on managing immunotherapy-related rheumatic irAEs

Author:
Claire Barnard

medwireNews: EULAR has issued recommendations on the management of rheumatic immune-related adverse events (irAEs) in people with cancer treated with immune checkpoint inhibitors (ICIs).

These agents, including PD-1, PD-L1, and CTLA-4 inhibitors, enhance antitumor T-cell activity, leading to long-lasting responses, and ICIs “represent a growing class of agents across multiple tumour types and at all stages of disease,” explain Marie Kostine (University Hospital of Bordeaux, France) and co-authors in the Annals of the Rheumatic Diseases.

They say that “specific rheumatic manifestations have been described rather rarely in randomised clinical trials” of ICIs, but events such as arthralgia, arthritis, myositis, and musculoskeletal pain “are much more common in clinical practice” and “represent a new spectrum of [rheumatic and musculoskeletal diseases] that rheumatologists should familiarise [themselves] with.”

The EULAR recommendations – developed by a collaboration of specialists including rheumatologists, oncologists, and internists, as well patient representatives – define the role of the rheumatologist in managing ICI-related irAEs, emphasizing the importance of early rheumatology referral. The experts also provide guidance on the different treatment options for rheumatic irAEs.

Kostine et al stress that “[e]arly consultation and strong collaboration between the referring oncologist, the treating rheumatologist, potentially other organ specialists and the patient are all required for optimal irAEs management.”

They note that the recommendations are “based almost entirely on low levels of evidence and on [expert] opinion,” and “will undoubtedly require updating over the next few years, as new data emerge.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-217139

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