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Clinical Guidelines

CRA/CanRIO guidelines for the management of baseline immunosuppression in individuals with pre-existing rheumatic diseases initiating immune checkpoint inhibitors

September 1, 2025

This living guideline offers up-to-date guidance on the management of baseline immunosuppression (IS) for pre-existing rheumatic diseases (PRDs) when initiating cancer immunotherapy with immune checkpoint inhibitors (ICIs). Split into 2 parts, this guideline provides contemporary baseline IS recommendations for individuals with cancer and PRDs when initiating ICI therapy.

Part 1: includes recommendations for pre-existing inflammatory arthritides (rheumatoid arthritis, polymyalgia rheumatica, psoriatic arthritis, spondyloarthritis)

Part 2: includes recommendations for pre-existing systemic autoimmune rheumatic diseases (systemic sclerosis, systemic lupus erythematosus, Sjögen’s disease, myositis, vasculitis, Behcet’s disease, sarcoidosis)