Table 2 General guidance for corticosteroid management of immune-related adverse events
Grade of immune-related AE (CTCAE/equivalent) | Corticosteroid management | Additional notes |
|---|---|---|
1 | • Corticosteroids not usually indicated | • Continue immunotherapy |
2 | • If indicated, start oral prednisone 0.5-1 mg/kg/day if patient can take oral medication. • If IV required, start methylprednisolone 0.5-1 mg/kg/day IV • If no improvement in 2–3 days, increase corticosteroid dose to 2 mg/kg/day • Once improved to ≤grade 1 AE, start 4–6 week steroid taper | • Hold immunotherapy during corticosteroid use • Continue immunotherapy once resolved to ≤grade 1 and off corticosteroids • Start proton pump inhibitor for GI prophylaxis |
3 | • Start prednisone 1-2 mg/kg/day (or equivalent dose of methylprednisolone) • If no improvement in 2–3 days, add additional/alternative immune suppressant • Once improved to ≤ grade 1, start 4–6-week steroid taper • Provide supportive treatment as needed | • Hold immunotherapy; if symptoms do not improve in 4–6 weeks, discontinue immunotherapy • Consider intravenous corticosteroids • Start proton pump inhibitor for GI prophylaxis • Add PCP prophylaxis if more than 3 weeks of immunosuppression expected (>30 mg prednisone or equivalent/day) |
4 | • Start prednisone 1-2 mg/kg/day (or equivalent dose of methylprednisolone) • If no improvement in 2–3 days, add additional/alternative immune suppressant, e.g., infliximab • Provide supportive care as needed | • Discontinue immunotherapy • Continue intravenous corticosteroids • Start proton pump inhibitor for GI prophylaxis • Add PCP prophylaxis if more than 3 weeks of immunosuppression expected (>30 mg prednisone or equivalent/day) |