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    Steroid Tapering and Supportive Treatment Guidance V1.0

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    yoga
    This document provides guidance on tapering steroid therapy for patients being treated for immune-related adverse events (irAEs). It recommends tapering oral steroids over 3-6 weeks and intravenous steroids over at least 6 weeks, monitoring patients regularly during tapering due to increased risk of irAE recurrence. It also gives supportive measures for managing common steroid side effects like hyperglycemia, insomnia, osteoporosis, and infection.

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    Steroid Tapering and Supportive Treatment Guidance V1.0

    Uploaded by

    yoga
    275 views1 page
    This document provides guidance on tapering steroid therapy for patients being treated for immune-related adverse events (irAEs). It recommends tapering oral steroids over 3-6 weeks and intravenous steroids over at least 6 weeks, monitoring patients regularly during tapering due to increased risk of irAE recurrence. It also gives supportive measures for managing common steroid side effects like hyperglycemia, insomnia, osteoporosis, and infection.

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    This document provides guidance on tapering steroid therapy for patients being treated for immune-related adverse events (irAEs). It recommends tapering oral steroids over 3-6 weeks and intravenous steroids over at least 6 weeks, monitoring patients regularly during tapering due to increased risk of irAE recurrence. It also gives supportive measures for managing common steroid side effects like hyperglycemia, insomnia, osteoporosis, and infection.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    275 views1 page

    Steroid Tapering and Supportive Treatment Guidance V1.0

    Uploaded by

    yoga
    This document provides guidance on tapering steroid therapy for patients being treated for immune-related adverse events (irAEs). It recommends tapering oral steroids over 3-6 weeks and intravenous steroids over at least 6 weeks, monitoring patients regularly during tapering due to increased risk of irAE recurrence. It also gives supportive measures for managing common steroid side effects like hyperglycemia, insomnia, osteoporosis, and infection.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    THE CLATTERBRIDGE CANCER CENTRE NHS FOUNDATION TRUST

    Steroid tapering guidance

    Many patients will receive moderate- to high-dose steroid therapy for their immune-related toxicity for several weeks.
    Length of tapering is usually dictated by the severity of the irAE. Regular monitoring during tapering is strongly
    advised as there is an increased risk of irAE recurrence.

    Oral steroid tapering: Intravenous steroid tapering:

    • Initiate corticosteroid taper over 3-6 weeks  Corticosteroid taper over at least 6 weeks
    Tapering guidance: Tapering guidance:
     Monitor patient by telephone twice weekly during taper.  Continue IV methylprednisolone 2mg/kg/day for a total
     Reduce prednisolone dose by 10mg every 3 days (as of 5 days then switch to oral prednisolone 1mg/kg/day x
    toxicity allows) until dose is 10mg/day. 3 days, then reduce to 60mg/day Prednisolone.
     Once steroid dose is 10mg/day, reduce by 5mg every 5 Upon discharge:
    days then stop.  Monitor patient by telephone twice weekly during taper.
     Reduce prednisolone dose by 10mg every 7 days (as
    toxicity allows) until dose is 10mg/day.
     Once steroid dose is 10mg/day, reduce by 5mg
    every 7 days then stop
    Supportive measures:

    Hyperglycaemia:

    A baseline HbA1c should be requested at steroid initiation and random afternoon blood sugar monitoring (BM)
    should be undertaken whilst on treatment. If new hyperglycemia is detected, Endocrinology advice should be
    sought (many patients will require short term insulin in this setting). Pre-existing diabetes may require escalation in
    oral hypoglycemic agents or insulin.

    Insomnia:

    This is the most common steroid-related side effect. Sleep hygiene counselling is important. Patients may require
    short-term use of zopiclone or benzodiazepines such as temazepam.

    Osteoporosis:

    Vitamin D and calcium levels should be taken at baseline and if low, replaced as appropriate. In patients on steroids
    for >3 months, or with pre-existing osteoporosis, risedronate or another bisphosphonate should be considered.

    Infection:

    In patients receiving the equivalent of prednisolone 25mg for > 6 weeks we suggest PCP prophylaxis with co-
    trimoxazole (80/400mg Mon/Wed/Fri).

    The oropharynx should be monitored for candidiasis and may require topical therapy such as Nilstat or even oral
    fluconazole.

    If patients are on other immuno-modulatory agents eg Mycophenylate mofetil, consideration may be given to CMV
    prophylaxis with valgancyclovir, especially if CMV IgG negative and lymphopenic.

    Issue Date: 17th March 2017 Page 1 of 1 Filename: GAMASTERO Version No: 1.0
    Author: Joanne Upton Authorised by: Immuno-Oncology Working Group Copy No:

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