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) |
Note: For steroid-refractory cases and/or when steroid sparing is desirable, management should be coordinated with disease specialists. AE, adverse event