From the Guidelines
For immune-related colitis, the recommended initial treatment is prednisone 1-2 mg/kg/day (typically 60-80 mg daily) or equivalent dexamethasone 0.2-0.4 mg/kg/day (approximately 10-20 mg daily). This recommendation is based on the most recent and highest quality study, which suggests that these doses are effective in suppressing the overactive immune response causing inflammation in the colon 1. The treatment should be continued until symptoms improve, typically for 1-2 weeks, and then tapered gradually over 4-6 weeks.
Key Considerations
- The initial dose of prednisone or equivalent dexamethasone should be administered until symptoms improve to grade 1, and then tapered over 4-6 weeks 1.
- For severe cases unresponsive to steroids within 3-5 days, consider adding infliximab 5 mg/kg 1.
- Monitor for symptom improvement, including reduced diarrhea frequency and abdominal pain, and provide supportive care with fluid and electrolyte replacement.
- Patients should avoid high-fiber foods, dairy, and spicy foods during active inflammation.
Escalation to Biologics
- If symptoms worsen during steroid taper or if there's no improvement after 3-5 days of high-dose steroids, consult gastroenterology and oncology for possible escalation to biologics 1.
- Infliximab and vedolizumab are reasonable options for treatment of glucocorticoid refractory colitis 1.
Important Notes
- Infectious causes of diarrhea should be excluded before treatment of suspected ICI colitis 1.
- Endoscopic confirmation of the diagnosis and severity of ICI colitis should be considered before initiation of high-dose systemic glucocorticoids 1.
- Patients who develop ICI colitis may be retreated with immunotherapy under select conditions 1.
From the Research
Immune Colitis Treatment
- The treatment of immune colitis often involves the use of corticosteroids, such as prednisone or dexamethasone, to reduce inflammation and suppress the immune system 2.
- The dose and duration of corticosteroid treatment can vary depending on the severity of the condition and the individual patient's response to treatment.
Corticosteroid Dosing
- A study published in 2014 found that patients with moderately active ulcerative colitis who failed to respond to oral corticosteroids (median dose 60mg/day) were treated with intravenous corticosteroids, with an initial response rate of 75% 3.
- Another study published in 2020 discussed the use of corticosteroids in the treatment of ulcerative colitis, but did not provide specific dosing recommendations for immune colitis 4.
- A 2021 study on the diagnosis and management of immune checkpoint inhibitor colitis recommended treating patients with grade 2 or higher symptoms with systemic corticosteroids, but did not specify a particular dose or duration of treatment 2.
Alternative Therapies
- A 2023 review of inflammatory bowel disease therapy discussed the use of biologic drugs and JAK inhibitors in the treatment of steroid-refractory Crohn's disease and ulcerative colitis, but did not provide specific recommendations for immune colitis 5.
- A 2025 study compared the effectiveness of infliximab plus azathioprine versus azathioprine alone in patients with acute severe ulcerative colitis responsive to intravenous steroids, but did not address immune colitis specifically 6.