Did the diarrhea stop within 72h (2)
Yes, it stopped within 72 hours
Initiate oral methylprednisolone* at a dose of 2x 32 mg per day
Taper steroids every 5 days (provide taper plan on paper to the patient)
Control blood tests weekly until normal or return to baseline In case or recurrence, treat according to medium risk management guidelines
Resume ICPi >1 week a er stopping steroid therapy and in the absence of diarrhea/colitis recurrence
No, it dit not stop within 72 hours
Consider repeat colonoscopy with biopsy and coproculture
Administer a second dose of infliximab 5mg/kg + continue methylprednisolone 40mg iv BID in the absence of any indication for infection
Did the diarrhea stop within 72 hours?
| Yes
Initiate oral methylprednisolone (medal) at a dose of 2x 32 mg per day. Taper steroids every 5 days (provide taper plan on paper to the patient) Control blood tests weekly until normal or return to baseline Resume ICPi >1 week aft er stopping steroid therapy and in the absence of diarrhea/colitis recurrence |
No
Consider repeat colonoscopy with biopsy and coproculture Consider starting mycophenolate mofetyl in case of persistent lymphocytic colitis without evidence for infection |
Abbrevations
H: Hematology
C: Chemistry
ICPi: Immune Checkpoint Blockade Inhibition
Hb: Hemoglobin
CRP: C Reactive Protein
BP: Blood Pressure
