Arthritis unter Therapie mit Immuncheckpoint-Inhibitoren

Immuncheckpoint-Inhibitoren:

Anti-PD1: nivolumab, pembrolizumab, cemiplimab, sintilimab, tislelizumab,toripalumab, spartalimumab

(Programmed cell death)

Anti-PD-L1: atezolizumab, avelumab, durvalumab

(Programmed cell death ligand)

Anti-CTLA4: ipilimumab (T-cell cytotoxic T-lymphocyte-associated protein 4)

Nat Rev Rheumatol14,569–579 (2018)

1-7 % von Patientenin klinische Studien, 1.5-22% in Kohorten. Kinik: von rasch nach Therapiebeginn bis zu einem Jahr oder später, Mono-, oligo-bis Polyarthritis der grössenGelenke, seltener EM als Kleingelenkarthritis, Tenosynovitiden, Enthesitiden, entzündliche Rückenschmerzen, analog zu RA, Psoriasis-Arthritis, RS3PE. Verlauf: kann chronisch, möglicherweise aggressiv mit rasch progredienten Erosionen.

Labor: meistens RF-und Anti-CCP negativ, ggf. ANA tieftitrig, erhöhte Entzündungswerte

DD: Immunvermittelte Nebenwirkung der Immuncheckpoint-Inhibitoren (ICI), Aktivität der Tumorkrankheit (Metastasen), Paraneoplastisches Syndrom, Infekt, Kristallarthritis, Arthritis unabhängigv on der Tumortherapie, Arthritis-Mimics (z.B. Osteonekrose, Fraktur, Zellulitis, Bursitis), Aktivierte Arthrose, Periarthropathien

Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update

EULAR points to consider for the diagnosis and management of rheumatic immune-related adverse events due to cancer immunotherapy with checkpoint inhibitors

Therapie: NSAID / konventionelle Analgetika − Glukokortikoiden • i.a. (Mono-/Oligoarthritis) • p.o. / i.v. − csDMARDs • Methotrexat • Hydroxychloroquin, Sulfasalazin, Leflunomid − bDMARDs • TNF-Hemmer (Infliximab, Etanercept, Adalimumab) • IL-6 Hemmer (Tocilizumab)

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BrahmerJR, Abu-SbeihH, AsciertoPA, et al. Society forImmunotherapyofCancer (SITC) clinicalpracticeguidelineon immune checkpointinhibitor-relatedadverse events. Journal forImmunoTherapyofCancer 2021;9:e002435.

Schneider BJ, Naidoo J, SantomassoBD, et al. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. J Clin Oncol. 2021 Dec 20;39(36):4073-4126.

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Calabrese, L.H., Calabrese, C. & Cappelli, L.C. Rheumaticimmune-relatedadverseeventsfromcancerimmunotherapy. NatRevRheumatol14, 569–579 (2018).

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