Journal of Rheumatic Diseases

Table. 1.

General management guideline of immune-related adverse events

Severity CTCAE grade Type of patient care Use of steroid Use of additional immunosuppressive agents Continuation of next cycle immunotherapy Other medication
1 Outpatient Generally, not necessary Not recommended Continue Not recommended
2 Outpatient Topical steroids or oral steroids: Prednisone 0.5∼1 mg/kg/d Not recommended Suspend temporarily: outside skin or endocrine disorders, where immunotherapy can be maintained Not recommended
3∼4 Consider hospitalization according to the specific case IV or oral steroids; prednisone or methylprednisolone 1∼2 mg/kg/d for 48∼72 hours, then reduce to 1 mg/kg/d; course of generally 2∼4 weeks; steroids must be reduced gradually over a period of at least 1 month Considered administration of infliximab (5 mg/Kg) and eventually repeat after 14 days; Consider mycophenolate mofetil (500 mg every 12 h) Skipping a dose of immunotherapy or discontinuing the immunotherapy can be considered, depending on the benefit/risk ratio of each given situation; If grade 4 toxicity occurs, discontinue permanently If a dose equivalent to 20 mg of prednisone is administered for over 4 weeks, consider prophylaxis for pneumocystis infections with trimethoprim/sulfamethoxazole (80+40 mg/d or 160/800 mg TIW)

CTCAE: common terminology criteria for adverse events, TIW: 3 times a week.

J Rheum Dis 2019;26:221~234
© J Rheum Dis