For a patient with ICI toxicity who is resistant to the use of high-dose steroids, are there scenarios where you would consider the use of first-line conventional synthetic DMARD in place of steroids?

Loaded question — I think we need a reframing of ICI-toxicity, much of the ICI side effects are just an autoimmune reaction in a specific organ.

High doses of steroids are used if there is a true risk for organ damage (like when you have acute ANCA vasculitis, lupus nephritis, etc.). So if a patient...

Yes, we do consider t-DMARDs or b-DMARDs early in the management of ICI rheumatic toxicities like inflammatory arthritis or myositis. We use DMARDs to control the toxicity and as steroid-sparing agents, for responders as well as non-responders to steroids. We typically prefer IL-6 inhibitors when we...

I will always attempt to avoid steroids- this is a fundamental principle in rheumatology.

For irAEs, the idea is to focus the immune system-- allow the ICI's to rev up the immune system and attack the cancer, then suppress the inflammatory proteins that are causing harm.

The first-line agent is depe...