How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?

I subscribe to the philosophy of "hitting hard, tapering slowly" for cases of pneumonitis, either radiation pneumonitis, or checkpoint inhibitor-related pneumonitis (some of those cases probably have mixed origin, with contributions from radiation and/or checkpoint inhibitors).

For severely symptomatic/extensive cases, I start with 60 mg of prednisone daily (either all in AM, or 2 doses divided between AM and PM), then go to 50 mg the next week, 40 mg the following week, 30 mg the next week, all...

Approach to treatment-related pneumonitis, whether drug or radiation-induced, should always be governed by the severity of the presentation. In my opinion, any patient with severe symptoms, new oxygen requirements, or out-of-field findings on imaging should be managed in concert with a pulmonologist. It’s both important to exclude confounding diagnoses but also to manage such patients in a multidisciplinary fashion.

That being said, my approach to most patients is to begin with 0.75-1 mg/kg/day ...