From the Guidelines
Pneumonitis treatment should prioritize corticosteroids as the mainstay of treatment, with methylprednisolone 1 mg/kg/day being a recommended dose for symptomatic cases, as per the guidelines from the Society for Immunotherapy of Cancer 1. The treatment approach for pneumonitis depends on the severity of the condition, with mild cases potentially resolving with removal of the triggering agent, while more severe cases require immediate medical attention and hospitalization.
- For grade 1 pneumonitis, consideration of holding immune checkpoint inhibitors (ICIs) and close monitoring with pulmonary and infectious disease consultations is recommended 1.
- For grade 2 pneumonitis, holding ICIs and initiating methylprednisolone 1 mg/kg/day, with consideration of hospitalization and pulmonary consultation for bronchoscopy, is advised 1.
- For grade 3-4 pneumonitis, permanent discontinuation of ICIs and hospitalization, with consideration of ICU care, is necessary 1. Supportive care, including supplemental oxygen and mechanical ventilation in severe cases, is crucial in managing pneumonitis.
- The use of immunosuppressants like mycophenolate mofetil, infliximab, or intravenous immune globulin may be considered for steroid-refractory cases, as suggested by the American Society of Clinical Oncology and the European Society for Medical Oncology guidelines 1.
- Pulmonary rehabilitation can help improve lung function and exercise capacity in patients with pneumonitis. It is essential to note that the treatment of pneumonitis should be individualized, taking into account the underlying cause, severity of symptoms, and patient response to treatment, as emphasized in the guidelines from the Society for Immunotherapy of Cancer and the American Society of Clinical Oncology 1.
From the FDA Drug Label
Treatment of pneumonia In the treatment of pneumonia, azithromycin has only been shown to be safe and effective in the treatment of community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia)
The treatment for pneumonitis is not explicitly stated in the provided drug labels for the specific condition of pneumonitis. However, for community-acquired pneumonia, azithromycin is indicated for the treatment of mild to moderate infections caused by susceptible strains of designated microorganisms.
- Key considerations:
- Azithromycin should only be used in patients appropriate for oral therapy.
- Patients with moderate to severe illness or certain risk factors should not be treated with azithromycin.
- The drug labels do not provide information on the treatment of pneumonitis specifically, only community-acquired pneumonia. 2
From the Research
Treatment Options for Pneumonitis
- The treatment for pneumonitis often involves the use of corticosteroids, such as prednisone, as the first line of treatment 3, 4, 5.
- In cases of immune-related pneumonitis, low-dose glucocorticoids may be maintained to prevent recurrence 3.
- For community-acquired pneumonia, the use of systemic corticosteroids as adjuvant therapy remains controversial, with some studies suggesting potential benefits in select groups of patients 4.
- Inhaled corticosteroids, with or without beta agonists, may also be used as adjuvant therapy in community-acquired pneumonia, although more research is needed to establish their clinical benefit 4.
Treatment of Steroid-Refractory Pneumonitis
- For steroid-refractory ICI-pneumonitis, treatment options include intravenous immunoglobulin (IVIG), infliximab, or a combination of both 6.
- IVIG alone has been shown to improve level-of-care and oxygenation requirements, with fewer fatalities compared to treatment with infliximab 6.
General Principles of Treatment
- Early detection and treatment of pneumonitis with corticosteroids can lead to complete resolution of symptoms 5.
- The treatment approach may vary depending on the underlying cause of pneumonitis, such as drug-induced pneumonitis or community-acquired pneumonia 5, 7.
- Immunocompromised patients with suspected community-acquired pneumonia require special consideration, and a consensus statement has been developed to guide initial treatment strategies 7.