Ahhh, prednisone and its family are nasty stuff --even if needed, sometimes. That could be. What we know from ipilimumab --Yervoy, anti CTL4, other immunotherapy, around since years ago is that ''In clinical trials, rapid corticosteroid tapering resulted in recurrence or worsening symptoms of enterocolitis in some patients.'' And those for those who had a lower AE grade than you --not bleeding.
Re: diarrhea/ colitis from immuno:
There are several published algorithms for the management of diarrhea, as the one included in the Summary of Product Characteristics (SPC) of ipilimumab. Most guidelines include recommendations for management based on grading and severity and sequential algorithms. Since 2005, specific guidelines for diarrhea management have been implemented in all the clinical studies involving ipilimumab and soon it was realized that this intervention reduced the incidence of severe GI toxicities and perforations even when higher doses of ipilimumab were used (29,30). This detailed guidance algorithm can be found in the SPC of ipilimumab (20). In general, when a patient on ipilimumab therapy presents with diarrhea or blood in stools, initially we have to rule out non-immune related causes, such as microbial infections. In such cases specific treatment is administered and when the event is resolved ipilimumab can be continued. The grade of the event should be properly assessed. In grade 1
diarrhea it is recommended to treat symptomatically without steroids, administer loperamide 2 mg per os q 4–6 hours, anti-diarrheic diet and hydration and monitor closely until resolution.
In grade 2
diarrhea, that is increase to 4–6 bowel movements, or abdominal pain or blood in stools, if initial symptomatic treatment without steroids is not effective, stool white blood cell (WBC) should be send and stool calprotectin and endoscopy should be considered. Treatment with oral budesonide or other moderate dose steroid should be initiated. Steroid tapering should be gradual and definitely not shorter than 30 days, since premature stopping might lead to relapse
. In grade 3
colitis (increase of ≥7 stools per day over baseline, incontinence, need for hospitalization for IV fluids for ≥24 h) then treatment with high dose steroids is required (methylprednisolone 1–2 mg/kg/day IV until improvement with a slow tapering for at least a month). If no response is seen in 1 week, then it is recommended to consider immunosuppressive therapy with anti-TNF inhibitors (5 mg/kg remicade, infliximab), which are approved for the treatment of colitis (29,30). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971373/
Dietary, only can think of boiled white rice with butter and a lot of grated cheese --hard cheese--, white crackers, and grate a raw apple, allow some time for it to turn brown, only eat when it is brown.
In other circumstances, I would think of adding a med, loperamide, but you really really need to check with your team, because this is not 'just' diarrhea.
Wish I could be of any help, veckon... sending strong thoughts your way. It will take some more time, but it will get resolved!