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)
