Wie gestalte ich die Basistherapie bei rheumatologischen Patient*innen mit maligner Vorerkrankung?

 

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Zusammenfassung

Rheumatologische Therapie bei Patient*innen mit Malignomanamnese ist mit komplexen Fragestellungen verbunden. Die European Alliance of Associations for Rheumatology (EULAR) hat Empfehlungen zum Umgang mit Basistherapie bei Patient*innen mit malignen Vorerkrankungen erarbeitet. Diese wurden in der vorläufigen Version auf dem EULAR Kongress 2023 vorgestellt. Die wichtigsten Empfehlungen werden herausgegriffen und vor dem Hintergrund aktueller Literatur kommentiert. Die Therapie von Inflammation erscheint wichtig um das Krebsrisiko zu reduzieren. Bei Patient*innen mit maligner Vorerkrankung sollten Januskinaseninhibitoren (JAKi) und Abatacept zurückhaltend und nur mit Vorsicht eingesetzt werden. Bei Vorerkrankung mit einem soliden Malignom werden Anti-Zytokininhibitoren und bei Lymphomen Rituximab bevorzugt. Rheumatologische Therapie bei malignen Erkrankungen, die sich nicht in Remission befinden, bedürfen einer interdisziplinären Therapieentscheidung.

Abstract

Rheumatological therapy in patients with a history of malignancy is associated with complex issues. The European Alliance of Associations for Rheumatology (EULAR) developed recommendations for dealing with disease-modifying antirheumatic drug (DMARD) therapy in patients with a history of malignant disease. A preliminary version of these recommendations was presented at the EULAR Congress in 2023. This article highlights the most important recommendations, commenting on them based on the current literature. The treatment of inflammation appears to be important to reduce the risk of cancer. Janus kinase inhibitors (JAKi) and abatacept should be used with caution in patients with a history of malignancy. Anti-cytokine inhibitors are preferred for patients with a history of solid malignancy, while rituximab is preferred for lymphomas. Rheumatological therapy for malignant diseases that are not in remission requires an interdisciplinary treatment decision.

Publication History

Article published online:
18 June 2024

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