EULAR guidance on immune-related side effects of cancer treatment


  • Dawn O'Shea
  • Univadis Medical News
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The European League Against Rheumatism (EULAR) has published recommendations around rheumatic immune-related adverse events (irAEs) caused by cancer treatment with checkpoint inhibitors (ICI).

EULAR recommends that the following 10 points should be considered:

  • Awareness of the wide spectrum of clinical presentations of rheumatic immune-related adverse events.
  • Encourage and facilitate liaison between rheumatologists and oncologists.
  • Metastases, paraneoplastic syndromes or unrelated rheumatic diseases might look like irAEs.
  • Steroids (local/systemic) should be considered for irAEs (tapered to lowest effective dose).
  • Conventional synthetic disease-modifying antirheumatic drugs (csDMARD) should be considered when the response to glucocorticoids is insufficient or for glucocorticoid-sparing.
  • Biological DMARD (bDMARD) should be considered for severe rheumatic and systemic irAEs or insufficient response to csDMARDs. TNF or IL-6 inhibitors are preferred for inflammatory arthritis.
  • Hold or continue immunotherapy based on severity, required immunosuppressive regimen, tumour response and duration, and future oncology plan, in consultation with the patient.
  • Myositis can be a severe condition; immunotherapy withdrawal should be discussed. For life-threatening symptoms, high-dose glucocorticoids plus other treatments should be used instead.
  • Cancer immunotherapy can be used in patients with pre-existing autoimmune rheumatic and/or systemic disease. Immunosuppressive regimen should be at the lowest dose.
  • Autoantibody testing is not indicated for all patients before starting cancer treatment.