Shorter versus longer corticosteroid duration and recurrent immune checkpoint inhibitor-Associated AKI

Shruti Gupta, Clara Garcia-Carro, Jason M. Prosek, Ilya Glezerman, Sandra M. Herrmann, Pablo Garcia, Ala Abudayyeh, Nuttha Lumlertgul, A. Bilal Malik, Sebastian Loew, Pazit Beckerman, Amanda D. Renaghan, Christopher A. Carlos, Arash Rashidi, Zain Mithani, Priya Deshpande, Sunil Rangarajan, Chintan V. Shah, Sophie De Seigneux, Luca CampedelAbhijat Kitchlu, Daniel Sanghoon Shin, Gaia Coppock, David I. Ortiz-Melo, Ben Sprangers, Vikram Aggarwal, Karolina Benesova, Rimda Wanchoo, Naoka Murakami, Frank B. Cortazar, Kerry L. Reynolds, Meghan E. Sise, Maria Jose Soler, David E. Leaf

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Abstract

Background Corticosteroids are the mainstay of treatment for immune checkpoint inhibitor-Associated acute kidney injury (ICPi-AKI), but the optimal duration of therapy has not been established. Prolonged use of corticosteroids can cause numerous adverse effects and may decrease progression-free survival among patients treated with ICPis. We sought to determine whether a shorter duration of corticosteroids was equally efficacious and safe as compared with a longer duration. Methods We used data from an international multicenter cohort study of patients diagnosed with ICPi-AKI from 29 centers across nine countries. We examined whether a shorter duration of corticosteroids (28 days or less) was associated with a higher rate of recurrent ICPi-AKI or death within 30 days following completion of corticosteroid treatment as compared with a longer duration (29-84 days). Results Of 165 patients treated with corticosteroids, 56 (34%) received a shorter duration of treatment and 109 (66%) received a longer duration. Patients in the shorter versus longer duration groups were similar with respect to baseline and ICPi-AKI characteristics. Five of 56 patients (8.9%) in the shorter duration group and 12 of 109 (11%) in the longer duration group developed recurrent ICPi-AKI or died (p=0.90). Nadir serum creatinine in the first 14, 28, and 90 days following completion of corticosteroid treatment was similar between groups (p=0.40, p=0.56, and p=0.89, respectively). Conclusion A shorter duration of corticosteroids (28 days or less) may be safe for patients with ICPi-AKI. However, the findings may be susceptible to unmeasured confounding and further research from randomized clinical trials is needed.

Original languageEnglish
Article numbere005646
JournalJournal for ImmunoTherapy of Cancer
Volume10
Issue number9
DOIs
StatePublished - 22 Sep 2022

Keywords

  • Immunotherapy

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