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12. Prevention and Management of Adverse Events Related
to Steroid Use
12.1 Pretreatment considerations
• Baseline workup to include viral hepatitis B and C serolog y and consideration for
latent/active TB test, as appropriate. HIV viral load and CD4 count would be
appropriate in patients with pre-existing HIV.
• Patients with preexisting comorbid conditions, such as DM, hypertension, HF,
cataract or glaucoma, infection or osteoporosis, should have their condition optimally
managed prior to commencing steroids.
• Ideal steroid dosing and duration is individualized and can vary by patient, oncologic
agents and type of irAE. Please refer to each individual irAE section for more detail.
• The lowest dose of steroids should be used for the shortest duration of time needed
to achieve treatment goals and control deleterious effects of irAE since the risk of
toxicity with steroids is generally dose- and duration-dependent.
12.2 Prevention of opportunistic infection
• Use of prophylaxis for an opportunistic infection with PJP may be considered once
a patient has received a prednisone equivalent of ≥20 mg/day for 4 or more weeks
or >30 mg for 3 weeks or more. Physicians may proceed according to institutional
guidelines.
• The role of prophylactic fluconazole with prolonged steroid use (>12 weeks) remains
unclear and physicians should proceed according to institutional guidelines.
• Use of prophylaxis against herpes zoster reactivation may be offered to patients who
have had zoster before and will be receiving corticosteroids.
