Immune checkpoint inhibitor (anti-PD-1, e.g., pembrolizumab) associated pneumonitis as an immune-related adverse event is BEST managed initially with:

• A Discontinuing pembrolizumab permanently and administering high-dose systemic corticosteroids ✓
• B Continuing pembrolizumab with inhaled corticosteroid therapy only
• C Stopping pembrolizumab and adding prophylactic co-trimoxazole alone
• D Administering anti-TNF infliximab immediately as first-line treatment for ICI pneumonitis

Explanation

Immune-related adverse events (irAEs) from anti-PD-1/PD-L1 inhibitors such as pneumonitis, colitis, and hepatitis require systemic immunosuppression. Grade 2+ pneumonitis requires holding the ICI and initiating high-dose systemic glucocorticoids (prednisolone 1 mg/kg/day or equivalent). Severe grade 3–4 pneumonitis requires IV methylprednisolone and typically permanent discontinuation of the ICI. Inhaled corticosteroids alone (option B) are insufficient for systemic irAE. Anti-TNF agents (infliximab) are reserved for steroid-refractory colitis, not as first-line for pneumonitis.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.