%0 Journal Article
%T Corticosteroids for the management of immune
%A David W Henry
%A Dennis W Grauer
%A Kiersten J Williams
%A Michelle L Rockey
%J Journal of Oncology Pharmacy Practice
%@ 1477-092X
%D 2019
%R 10.1177/1078155217744872
%X Due to enhanced T-cell activity, immune checkpoint inhibitors cause immune-related adverse effects. Corticosteroids are the mainstay of immune-related adverse effect management but the optimal strategy has not been determined, putting patients at risk for steroid-related adverse effects and potentially decreased efficacy of immunotherapy. This study aims to characterize the use of corticosteroids for the management of immune-related adverse effect. A retrospective, single-center evaluation of patients receiving checkpoint inhibitors was conducted. The primary objective was to evaluate corticosteroid use for immune-related adverse effects, including starting dose, taper strategy, total duration, and resumption of immunotherapy. Secondary objective was to describe the incidence and significance of hyperglycemia. One hundred and three patients met inclusion criteria and experienced 123 immune-related adverse effects. Prednisone was used most commonly (67%) at an average starting dose of 0.88ˋmg/kg (range 0.07每17.0). On average, steroid tapers began 9.2 days after initiation (range 0每89) and were continued for a total of 84.2 days (range 3每693). In 21.1% of cases, checkpoint inhibitor therapy was not delayed and 68.6% resumed checkpoint inhibitors, while the patient was taking steroids (30.4ˋmg prednisone on average, range 5每80). On average, checkpoint inhibitor therapy was resumed 18.6 days after detection of immune-related adverse effect (range 0每150). Clinically relevant hyperglycemia occurred in 8.9%. Utilization of steroids for immune-related adverse effect at our institution is highly variable. The majority of patients received prolonged courses of steroids and resumed checkpoint inhibitor therapy with concomitant steroids above recommended doses. Additional monitoring for hyperglycemia and other steroid associated adverse effects should be considered
%K Checkpoint inhibitors
%K corticosteroids
%K immune mediated side effects
%K immune-related adverse effect
%K steroid toxicity
%U https://journals.sagepub.com/doi/full/10.1177/1078155217744872