A three-week steroid taper fell short of six weeks for mild checkpoint-inhibitor pneumonitis

The edition in brief

In the first randomised trial of steroid duration for immune checkpoint inhibitor pneumonitis, 106 patients with grade 1–2 disease were assigned a 3-week or 6-week taper. Success at 8 weeks was 66.7% with 3 weeks and 85.2% with 6 weeks; non-inferiority was not shown and an exploratory analysis favoured 6 weeks, though grade 3 or worse adverse events were more frequent with longer treatment (24% vs 12%). The 2026 GINA report keeps inhaled corticosteroid-containing treatment for all and recommends against SABA-only treatment, prefers as-needed or maintenance-and-reliever low-dose ICS-formoterol in adults and adolescents, and expands reliever options and acute care guidance. In two US IPF data sources, about four in ten patients reduced or stopped antifibrotics; progression was common whatever the dose, and associations with dose changes were inconsistent between sources. A CHEST review argues that LDCT screening beyond smokers, as practised in China, has shown stage shift but not yet mortality benefit, and may add overdiagnosis.