Department of Medicine V, Division of Rheumatology, University Medical Centre, Mannheim, Munich, Germany.
Department of Internal Medicine IV, Division of Rheumatology and Clinical Immunology, University of Munich, Munich, Germany.
Rheumatology (Oxford). 2019 Dec 1;58(Suppl 7):vii49-vii58. doi: 10.1093/rheumatology/kez360.
Since immune checkpoint inhibitors became the standard of care for an increasing number of indications, more patients have been exposed to these drugs and physicians are more challenged with the management of a unique spectrum of immune-related adverse events (irAEs) associated with immune checkpoint inhibitors. Those irAEs of autoimmune or autoinflammatory origin, or both, can involve any organ or tissue, but most commonly affect the dermatological, gastrointestinal and endocrine systems. Rheumatic/systemic irAEs seem to be less frequent (although underreporting in clinical trials is probable), but information on their management is highly relevant given that they can persist longer than other irAEs. Their management consists of anti-inflammatory treatment including glucocorticoids, synthetic and biologic immunomodulatory/immunosuppressive drugs, symptomatic therapies as well as holding or, rarely, discontinuation of immune checkpoint inhibitors. Here, we summarize the management of rheumatic/systemic irAEs based on data from clinical trials but mainly from published case reports and series, contextualize them and propose perspectives for their treatment.
由于免疫检查点抑制剂在越来越多的适应症中成为标准治疗方法,更多的患者接触到这些药物,医生也面临着与免疫检查点抑制剂相关的独特免疫相关不良事件(irAE)谱的管理挑战。这些源自自身免疫或自身炎症的 irAE,或两者兼有,可以涉及任何器官或组织,但最常见的是影响皮肤、胃肠道和内分泌系统。风湿/系统性 irAE 似乎不太常见(尽管临床试验中可能存在漏报),但鉴于它们比其他 irAE 持续时间更长,因此关于其管理的信息非常重要。它们的管理包括抗炎治疗,包括糖皮质激素、合成和生物免疫调节剂/免疫抑制剂、对症治疗以及免疫检查点抑制剂的停药或很少情况下的停药。在这里,我们根据临床试验但主要是基于已发表的病例报告和系列研究的数据总结了风湿/系统性 irAE 的管理,对其进行了背景分析,并提出了治疗的观点。