Особенности инициации таргетной терапии по рекомендациям EULAR у пациентов с иммуновоспалительными заболеваниями суставов и злокачественными новообразованиями в анамнезе

Потенциальная связь между таргетной терапией и злокачественными новообразованиями (ЗНО) у пациентов с воспалительными заболеваниями суставов и перенесенными ранее ЗНО часто вызывает вопросы в повседневной ревматологической практике. В 2024 г. рабочая группа EULAR (European Alliance of Associations for Rheumatology) сформулировала пять основополагающих принципов и семь гипотез в отношении инициации таргетной терапии у пациентов с активным артритом и ЗНО в стадии ремиссии, а также одну гипотезу для пациентов с активным артритом, у которых ремиссия онкологического заболевания не была достигнута.
Основные вопросы включали: а) необходимость оценки индивидуального риска рецидива онкологического заболевания в зависимости от особенностей пациента, ЗНО и основного заболевания; б) важность взаимодействия со специалистами по лечению онкологических заболеваний и определения тактики терапии на основе совместного решения пациента и ревматолога; в) необходимость безотлагательного начала соответствующей таргетной терапии артрита у пациентов с ремиссией онкологического заболевания; г) предложение применять ингибиторы Янус-киназ и абатацепт с осторожностью и только в отсутствие альтернативных опций, поскольку нет данных об их использовании в связи с предыдущими ЗНО.
В рамках настоящих рекомендаций были разработаны пункты, требующие особого внимания при назначении таргетной терапии пациентам с активным артритом и ЗНО.

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