Considerations for Ruxolitinib Therapy in Steroid-Refractory cGVHD

Steroid Tapering with Second-Line Therapy

This detailed segment covers approaches to steroid tapering when initiating second-line therapy. The panelists agree on:

• Waiting 3-4 weeks after starting a new agent (like ruxolitinib) before beginning steroid taper
• Prioritizing steroid discontinuation before tapering other agents
• Tapering steroids by approximately 10mg every 4 weeks, slowing the taper at lower doses
• Very gradual tapering of ruxolitinib once steroids are discontinued, sometimes using alternate-day dosing

Dr Lee notes that at Fred Hutchinson Cancer Center, they taper ruxolitinib more slowly than the prescribing information recommends, sometimes tapering to 5 mg several days per week before complete discontinuation.