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EULAR points to consider for the diagnosis and management of rheumatic immune-related adverse events due to cancer immunotherapy with checkpoint inhibitors.
- Source :
-
Annals of the rheumatic diseases [Ann Rheum Dis] 2021 Jan; Vol. 80 (1), pp. 36-48. Date of Electronic Publication: 2020 Apr 23. - Publication Year :
- 2021
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Abstract
- Background: Rheumatic and musculoskeletal immune-related adverse events (irAEs) are observed in about 10% of patients with cancer receiving checkpoint inhibitors (CPIs). Given the recent emergence of these events and the lack of guidance for rheumatologists addressing them, a European League Against Rheumatism task force was convened to harmonise expert opinion regarding their identification and management.<br />Methods: First, the group formulated research questions for a systematic literature review. Then, based on literature and using a consensus procedure, 4 overarching principles and 10 points to consider were developed.<br />Results: The overarching principles defined the role of rheumatologists in the management of irAEs, highlighting the shared decision-making process between patients, oncologists and rheumatologists. The points to consider inform rheumatologists on the wide spectrum of musculoskeletal irAEs, not fulfilling usual classification criteria of rheumatic diseases, and their differential diagnoses. Early referral and facilitated access to rheumatologist are recommended, to document the target organ inflammation. Regarding therapeutic, three treatment escalations were defined: (1) local/systemic glucocorticoids if symptoms are not controlled by symptomatic treatment, then tapered to the lowest efficient dose, (2) conventional synthetic disease-modifying antirheumatic drugs, in case of inadequate response to glucocorticoids or for steroid sparing and (3) biological disease-modifying antirheumatic drugs, for severe or refractory irAEs. A warning has been made on severe myositis, a life-threatening situation, requiring high dose of glucocorticoids and close monitoring. For patients with pre-existing rheumatic disease, baseline immunosuppressive regimen should be kept at the lowest efficient dose before starting immunotherapies.<br />Conclusion: These statements provide guidance on diagnosis and management of rheumatic irAEs and aim to support future international collaborations.<br />Competing Interests: Competing interests: MK: honoraria from Abbvie, BMS, Lilly, Novartis, Pfizer; TRDJR: grants from AbbVie, Takeda, UCB, Janssen, GSK and honoraria from Abbvie, Pfizer, Takeda, Lilly, Medimmune, Novartis, GSK, BMS, AstraZeneca, Janssen; XM: honoraria from BMS; COB: grants and honoraria from BMS and honoraria from Genetech/Roche, Sanofi/Regeneron; OL: grant from Gilead and honoraria from BMS, MSD, AstraZeneca, Janssen; JLe: grants from Novartis, Pfizer and honoraria from Abbvie, AstraZeneca, BMS, Celgene, Hospira, Janssen-Cilag, LEO Pharma, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, UCB; AM: grants from BMS, Merus and honoraria from Merck Serono, Lytix, BMS, Symphogen, Amgen, AZ/Medimmune, Servier, Gritstone, Pierre Fabre, EISAI, Sanofi; TS: honoraria from Pfizer, Lilly, Novartis, BMS, Abbvie, Sanofi; EHC: grants from Biogen, grants and honoraria from Amgen, Bio-Cancer, Roche, UCB, Pfizer, honoraria from Chugai Pharma, Abbvie, BMS, Celgene, Eli Lilly, Janssen, ObsEva, Regeneron, Sanofi, SynAct Pharma, Tonix, Gilead; LT: honoraria from Novartis; KB: grants from Abbvie, Novartis, Rheumaliga Baden-Württemberg and honoraria from MSD, Abbvie, BMS, Janssen, Lilly, Mundipharma, Novartis, Pfizer, Roche, UCB; KV: speaker fees from BMS; JLa: grants from Aveo and Pharmacyclics, grants and honoraria from Achilles Therapeutics, MSD, Nektar, Novartis, Pierre Fabre, Pfizer, Roche/Genetech and Immunocore, honoraria from AstraZeneca, Boston Biomedical, BMS, Eisai, EUSA Pharma, GSK, Ipsen, Imugen, Incyte, iOnctura, Kymab, Merck Serono, Secarna, Vitaccess and Covance; JBAGH: grants from BMS, Novartis and advisory boards and/or lectures for MSD, BMS, Roche, Novartis; J-EG: grants from BMS, UCB, Pfizer, Sanofi and honoraria from BMS, Lilly, Pfizer, Sanofi-Genzyme, UCB.<br /> (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Advisory Committees
Analgesics therapeutic use
Anti-Inflammatory Agents, Non-Steroidal therapeutic use
Arthralgia chemically induced
Arthralgia diagnosis
Arthralgia immunology
Arthralgia therapy
Arthritis, Psoriatic chemically induced
Arthritis, Psoriatic diagnosis
Arthritis, Psoriatic immunology
Arthritis, Psoriatic therapy
Arthritis, Reactive chemically induced
Arthritis, Reactive diagnosis
Arthritis, Reactive immunology
Arthritis, Reactive therapy
Autoantibodies immunology
Decision Making, Shared
Deprescriptions
Europe
Humans
Immunoglobulins, Intravenous therapeutic use
Immunologic Factors therapeutic use
Medical Oncology
Methotrexate therapeutic use
Myalgia chemically induced
Myalgia diagnosis
Myalgia immunology
Myalgia therapy
Myocarditis chemically induced
Myocarditis diagnosis
Myocarditis immunology
Myocarditis therapy
Myositis chemically induced
Myositis diagnosis
Myositis immunology
Myositis therapy
Plasma Exchange
Polymyalgia Rheumatica chemically induced
Polymyalgia Rheumatica diagnosis
Polymyalgia Rheumatica immunology
Polymyalgia Rheumatica therapy
Rheumatic Diseases chemically induced
Rheumatic Diseases diagnosis
Rheumatic Diseases immunology
Rheumatology
Severity of Illness Index
Societies, Medical
Tumor Necrosis Factor Inhibitors therapeutic use
Antirheumatic Agents therapeutic use
Glucocorticoids therapeutic use
Immune Checkpoint Inhibitors adverse effects
Neoplasms drug therapy
Rheumatic Diseases therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1468-2060
- Volume :
- 80
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Annals of the rheumatic diseases
- Publication Type :
- Academic Journal
- Accession number :
- 32327425
- Full Text :
- https://doi.org/10.1136/annrheumdis-2020-217139