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Immune-related Adverse Events from Immune Checkpoint Inhibitor Therapy

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42 Treatment Table 5. Musculoskeletal Toxicities G3–4: Severe stiffness and pain; limiting self- care ADL • Hold ICPi and may resume, in consultation with rheumatolog y, if recover to ≤G2. However, note that cases of toxicity returning upon rechallenge have been reported. • Referral to rheumatolog y. • Should initiate prednisone 40 mg/d or equivalent. If no improvement or need for higher dosages for prolonged time, may offer a steroid sparing agent such as synthetic drugs (e.g., methotrexate) or biologic agents (e.g., IL-6 antagonists). Note: As caution, IL-6 inhibition can cause intestinal perforation. While this is extremely rare, it should not be used in patients with immune- related colitis. • Consider admission of patients with severe symptoms. Additional considerations: • IL-6 antagonists may be the preferred steroid-sparing agents for management of polymyalgia-like syndrome as they are already approved for use in patients with GCA. (cont'd)

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