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Immune-related Adverse Events from Immune Checkpoint Inhibitor Therapy

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5 Contraindications and Cautions Corticosteroids are contraindicated in patients with known hypersensitivity to prednisone or any excipients in the formulation. Warnings that there is a risk of alterations in endocrine function, increased risk of infections, alterations in CV and renal function, risk of GI complications, behavioral and mood disturbances, decreased bone density, ophthalmic effects, neuromuscular effects, and caution in pregnancy use as fetal harm can occur. Warnings that systemic absorption of topical corticosteroids has produced reversible hypothalamic-pituitary-adrenal (HPA) axis suppression, manifestations of Cushing's syndrome, hyperglycemia, and glucosuria in some patients. Systemic absorption is typically rare, and is related to potency, body surface area treated, and duration of therapy. Conditions that augment systematic absorption include the application of the more potent steroids, use over large surface areas, prolonged use, and the addition of occlusive dressings. No contraindications. Warnings that concomitant use with a TNF antagonist can increase the risk of infections and serious infections. Hypersensitivity, anaphylaxis, and anaphylactoid reactions have been reported. Patients with a history of recurrent infections or underlying conditions predisposing to infections may experience more infections. Discontinue if a serious infection develops. Screen for latent TB infection prior to initiating therapy. Patients testing positive should be treated prior to initiating abatacept. Live vaccines should not be given concurrently or within 3 months of discontinuation. Based on its mechanism of action, abatacept may blunt the effectiveness of some immunizations. COPD patients may develop more frequent respiratory adverse events. Alemtuzumab is contraindicated in patients infected with Human Immunodeficiency Virus. Warning that alemtuzumab can causes serious, sometimes fatal, autoimmune conditions such as immune thrombocytopenia and antiglomerular basement membrane disease. Monitor complete blood counts with differential serum creatinine levels, and urinalysis with urine counts at periodic intervals for 48 months aer the last dose. Alemtuzumab may also cause serious and life-threatening infusion reactions and must be administered in a setting with appropriate equipment and personnel to manage anaphylaxis or serious infusion reactions. Monitor patients for two hours aer each infusion. Make patients aware that serious infusion reactions can also occur aer the 2-hour monitoring period. Alemtuzumab may also cause an increased risk of malignancies, including thyroid cancer, melanoma, and lymphoproliferative disorders.

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