Opinion
Video
Navigating the Path to Second-Line Therapy
Panelists discuss how second-line therapy selection and individualized care strategies are essential in chronic graft-vs-host disease (cGVHD) management, emphasizing the need to reduce steroid-related toxicity, address patient-specific factors, and leverage pharmacist expertise to optimize outcomes.
Navigating Second-Line Therapy and Individualized Care in Chronic Graft-vs-Host Disease
This segment of the Pharmacy Times peer exchange focuses on treatment progression in chronic graft-vs-host disease (cGVHD), particularly the transition to second-line therapies. While initial treatment typically begins with corticosteroids, many patients either do not respond or become steroid-dependent over time. Experts note that up to 75% to 80% of patients with cGVHD ultimately require a second-line agent to manage the disease effectively and reduce steroid-related toxicity. These decisions are influenced by the chronic nature of the condition, where treatment responses are measured in months rather than weeks.
Key considerations when escalating treatment include not only clinical response but also the burden of long-term steroid use. The addition of second-line agents often aims to mitigate adverse effects and improve quality of life. Importantly, many patients have prior exposure to steroids during treatment for acute graft-vs-host disease, meaning they are not steroid-naive and may already be at risk for cumulative complications. This historical context further supports the need for earlier consideration of alternative or adjunctive therapies.
Patient-specific factors are central to treatment decision-making. These include comorbidities, infection risk, previous treatment responses, and disease severity—particularly the presence of fibrotic manifestations. Practical concerns like access to care, insurance coverage, and the feasibility of intravenous administration also influence therapy choices. Pharmacists play a vital role in evaluating drug-drug interactions, managing supportive care, and coordinating logistics. By taking a comprehensive approach that considers both clinical and nonclinical variables, the care team can better tailor treatment strategies to the individual needs of each patient and improve long-term outcomes.
