Rapid corticosteroid taper versus standard of care for immune checkpoint inhibitor induced nephritis: a single-center retrospective cohort study
BackgroundCurrent guidelines for treatment of immune checkpoint inhibitor (ICI)-induced nephritis are not evidence based and may lead to excess corticosteroid exposure. We aimed to compare a rapid corticosteroid taper to standard of care.MethodsRetrospective cohort study in patients with ICI-induced...
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| Veröffentlicht in: | Journal for immunotherapy of cancer 2021-04, Vol.9 (4), p.e002292 |
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| creator | Lee, Meghan D Seethapathy, Harish Strohbehn, Ian A Zhao, Sophia H Boland, Genevieve M Fadden, Riley Sullivan, Ryan Reynolds, Kerry L Sise, Meghan E |
| description | BackgroundCurrent guidelines for treatment of immune checkpoint inhibitor (ICI)-induced nephritis are not evidence based and may lead to excess corticosteroid exposure. We aimed to compare a rapid corticosteroid taper to standard of care.MethodsRetrospective cohort study in patients with ICI-induced nephritis comparing a rapid taper beginning with 60 mg/day prednisone and tapered to 10 mg within 3 weeks to a historical control group that began 60 mg/day tapered to 10 mg within 6 weeks (standard of care). Renal recovery was defined as creatinine returning to within 1.5-fold baseline. The log-rank test compared the differences in time to renal recovery between the groups. We report rates of renal recovery at 30, 60 and 90 days, and timing and outcomes of ICI rechallenge.ResultsThirteen patients received rapid corticosteroid taper and 14 patients received standard of care. Baseline characteristics were similar between groups. The median time to ≤10 mg/day prednisone was 20 days (IQR 15–25) in the rapid-taper group compared with 38 days (IQR 30–58) in the standard-of-care group. There was no significant difference in the time to renal recovery between the groups, though numerically higher numbers of patients recovered by 30 days, 11 (85%) in the rapid-taper arm versus 6 (46%) in the standard of care arm. Exposure to other nephritis-causing medications (proton pump inhibitor or trimethoprim-sulfamethoxazole) during the corticosteroid taper was more common in the standard of care group, 9 (64%) versus rapid-taper group, 2 (15%), and was associated with longer time to renal recovery, 20 days (IQR 14–101) versus 13 days (IQR 7–34) in those that discontinued nephritis-causing medications. Fifteen (56%) of patients were rechallenged with ICIs, and only two (13%) developed recurrent nephritis.ConclusionsPatients with ICI-induced nephritis have excellent kidney outcomes when treated with corticosteroids that are tapered over 3 weeks. |
| doi_str_mv | 10.1136/jitc-2020-002292 |
| format | Article |
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We aimed to compare a rapid corticosteroid taper to standard of care.MethodsRetrospective cohort study in patients with ICI-induced nephritis comparing a rapid taper beginning with 60 mg/day prednisone and tapered to 10 mg within 3 weeks to a historical control group that began 60 mg/day tapered to 10 mg within 6 weeks (standard of care). Renal recovery was defined as creatinine returning to within 1.5-fold baseline. The log-rank test compared the differences in time to renal recovery between the groups. We report rates of renal recovery at 30, 60 and 90 days, and timing and outcomes of ICI rechallenge.ResultsThirteen patients received rapid corticosteroid taper and 14 patients received standard of care. Baseline characteristics were similar between groups. The median time to ≤10 mg/day prednisone was 20 days (IQR 15–25) in the rapid-taper group compared with 38 days (IQR 30–58) in the standard-of-care group. There was no significant difference in the time to renal recovery between the groups, though numerically higher numbers of patients recovered by 30 days, 11 (85%) in the rapid-taper arm versus 6 (46%) in the standard of care arm. Exposure to other nephritis-causing medications (proton pump inhibitor or trimethoprim-sulfamethoxazole) during the corticosteroid taper was more common in the standard of care group, 9 (64%) versus rapid-taper group, 2 (15%), and was associated with longer time to renal recovery, 20 days (IQR 14–101) versus 13 days (IQR 7–34) in those that discontinued nephritis-causing medications. Fifteen (56%) of patients were rechallenged with ICIs, and only two (13%) developed recurrent nephritis.ConclusionsPatients with ICI-induced nephritis have excellent kidney outcomes when treated with corticosteroids that are tapered over 3 weeks.</description><identifier>ISSN: 2051-1426</identifier><identifier>EISSN: 2051-1426</identifier><identifier>DOI: 10.1136/jitc-2020-002292</identifier><identifier>PMID: 33849926</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adrenal Cortex Hormones - administration & dosage ; Adrenal Cortex Hormones - adverse effects ; Aged ; Aged, 80 and over ; Anti-inflammatory agents ; Antibiotics ; Biopsy ; Boston ; Cancer ; Cancer therapies ; Clinical/Translational Cancer Immunotherapy ; Cohort analysis ; Creatinine ; Drug dosages ; Drug Tapering ; Female ; Humans ; Immune Checkpoint Inhibitors - adverse effects ; Immunotherapy ; Kidney diseases ; Male ; Middle Aged ; Nephritis - chemically induced ; Nephritis - drug therapy ; Nephritis - immunology ; Patients ; Prednisone - administration & dosage ; Prednisone - adverse effects ; Recovery of Function ; Remission (Medicine) ; Retrospective Studies ; Standard of care ; Steroids ; Time Factors ; Treatment Outcome</subject><ispartof>Journal for immunotherapy of cancer, 2021-04, Vol.9 (4), p.e002292</ispartof><rights>Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b592t-8d90bbcdf929641d5c19891e1a220ba38b7f27cf2aa898eca85572f7c277eee23</citedby><cites>FETCH-LOGICAL-b592t-8d90bbcdf929641d5c19891e1a220ba38b7f27cf2aa898eca85572f7c277eee23</cites><orcidid>0000-0002-6895-5968 ; 0000-0001-5344-6645</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jitc.bmj.com/content/9/4/e002292.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://jitc.bmj.com/content/9/4/e002292.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,27549,27550,27924,27925,53791,53793,77473,77504</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33849926$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Meghan D</creatorcontrib><creatorcontrib>Seethapathy, Harish</creatorcontrib><creatorcontrib>Strohbehn, Ian A</creatorcontrib><creatorcontrib>Zhao, Sophia H</creatorcontrib><creatorcontrib>Boland, Genevieve M</creatorcontrib><creatorcontrib>Fadden, Riley</creatorcontrib><creatorcontrib>Sullivan, Ryan</creatorcontrib><creatorcontrib>Reynolds, Kerry L</creatorcontrib><creatorcontrib>Sise, Meghan E</creatorcontrib><title>Rapid corticosteroid taper versus standard of care for immune checkpoint inhibitor induced nephritis: a single-center retrospective cohort study</title><title>Journal for immunotherapy of cancer</title><addtitle>J Immunother Cancer</addtitle><description>BackgroundCurrent guidelines for treatment of immune checkpoint inhibitor (ICI)-induced nephritis are not evidence based and may lead to excess corticosteroid exposure. We aimed to compare a rapid corticosteroid taper to standard of care.MethodsRetrospective cohort study in patients with ICI-induced nephritis comparing a rapid taper beginning with 60 mg/day prednisone and tapered to 10 mg within 3 weeks to a historical control group that began 60 mg/day tapered to 10 mg within 6 weeks (standard of care). Renal recovery was defined as creatinine returning to within 1.5-fold baseline. The log-rank test compared the differences in time to renal recovery between the groups. We report rates of renal recovery at 30, 60 and 90 days, and timing and outcomes of ICI rechallenge.ResultsThirteen patients received rapid corticosteroid taper and 14 patients received standard of care. Baseline characteristics were similar between groups. The median time to ≤10 mg/day prednisone was 20 days (IQR 15–25) in the rapid-taper group compared with 38 days (IQR 30–58) in the standard-of-care group. There was no significant difference in the time to renal recovery between the groups, though numerically higher numbers of patients recovered by 30 days, 11 (85%) in the rapid-taper arm versus 6 (46%) in the standard of care arm. Exposure to other nephritis-causing medications (proton pump inhibitor or trimethoprim-sulfamethoxazole) during the corticosteroid taper was more common in the standard of care group, 9 (64%) versus rapid-taper group, 2 (15%), and was associated with longer time to renal recovery, 20 days (IQR 14–101) versus 13 days (IQR 7–34) in those that discontinued nephritis-causing medications. Fifteen (56%) of patients were rechallenged with ICIs, and only two (13%) developed recurrent nephritis.ConclusionsPatients with ICI-induced nephritis have excellent kidney outcomes when treated with corticosteroids that are tapered over 3 weeks.</description><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Adrenal Cortex Hormones - adverse effects</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-inflammatory agents</subject><subject>Antibiotics</subject><subject>Biopsy</subject><subject>Boston</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Clinical/Translational Cancer Immunotherapy</subject><subject>Cohort analysis</subject><subject>Creatinine</subject><subject>Drug dosages</subject><subject>Drug Tapering</subject><subject>Female</subject><subject>Humans</subject><subject>Immune Checkpoint Inhibitors - adverse effects</subject><subject>Immunotherapy</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nephritis - chemically induced</subject><subject>Nephritis - drug therapy</subject><subject>Nephritis - immunology</subject><subject>Patients</subject><subject>Prednisone - administration & dosage</subject><subject>Prednisone - adverse effects</subject><subject>Recovery of Function</subject><subject>Remission (Medicine)</subject><subject>Retrospective Studies</subject><subject>Standard of care</subject><subject>Steroids</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>2051-1426</issn><issn>2051-1426</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNqFUk2LFDEQbURxl3HvniTgUVqT9FfiQZDFj4UFQfQc0pXq6bQzSZukB_Zf7E82ba_L7klyqCT16r1U6hXFS0bfMla17yaboOSU05JSziV_Upxz2rCS1bx9-mB_VlzEOFFKGa0qIcTz4izHWkrenhe33_VsDQEfkgUfEwafj0nPGMgJQ1wiiUk7o4MhfiCgA5LBB2KPx8UhgRHh1-ytS8S60fY2rTlnFkBDHM5jsMnG90STaN3-gCWgyxokYAo-zgjJnjKLH7N-FlrMzYvi2aAPES_u4q74-fnTj8uv5fW3L1eXH6_LvpE8lcJI2vdgBsllWzPTAJNCMmSac9rrSvTdwDsYuNZCCgQtmqbjQwe86xCRV7viauM1Xk9qDvaow43y2qq_Fz7slV7_5ICqFqYWDW8Bq6oWQGXfQdPQzCsB6rrNXB82rnnpj2jWHoM-PCJ9nHF2VHt_UiLPqM5j2RWv7wiC_71gTGryS3C5f8UbWbV5VSKj6IaC_Hcx4HCvwKhaLaFWS6jVEmqzRC559fBl9wX_DJABbzZAf5z-T_cH2t7D0A</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Lee, Meghan D</creator><creator>Seethapathy, Harish</creator><creator>Strohbehn, Ian A</creator><creator>Zhao, Sophia H</creator><creator>Boland, Genevieve M</creator><creator>Fadden, Riley</creator><creator>Sullivan, Ryan</creator><creator>Reynolds, Kerry L</creator><creator>Sise, Meghan E</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-6895-5968</orcidid><orcidid>https://orcid.org/0000-0001-5344-6645</orcidid></search><sort><creationdate>202104</creationdate><title>Rapid corticosteroid taper versus standard of care for immune checkpoint inhibitor induced nephritis: a single-center retrospective cohort study</title><author>Lee, Meghan D ; Seethapathy, Harish ; Strohbehn, Ian A ; Zhao, Sophia H ; Boland, Genevieve M ; Fadden, Riley ; Sullivan, Ryan ; Reynolds, Kerry L ; Sise, Meghan E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b592t-8d90bbcdf929641d5c19891e1a220ba38b7f27cf2aa898eca85572f7c277eee23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adrenal Cortex Hormones - adverse effects</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-inflammatory agents</topic><topic>Antibiotics</topic><topic>Biopsy</topic><topic>Boston</topic><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Clinical/Translational Cancer Immunotherapy</topic><topic>Cohort analysis</topic><topic>Creatinine</topic><topic>Drug dosages</topic><topic>Drug Tapering</topic><topic>Female</topic><topic>Humans</topic><topic>Immune Checkpoint Inhibitors - adverse effects</topic><topic>Immunotherapy</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nephritis - chemically induced</topic><topic>Nephritis - drug therapy</topic><topic>Nephritis - immunology</topic><topic>Patients</topic><topic>Prednisone - administration & dosage</topic><topic>Prednisone - adverse effects</topic><topic>Recovery of Function</topic><topic>Remission (Medicine)</topic><topic>Retrospective Studies</topic><topic>Standard of care</topic><topic>Steroids</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Meghan D</creatorcontrib><creatorcontrib>Seethapathy, Harish</creatorcontrib><creatorcontrib>Strohbehn, Ian A</creatorcontrib><creatorcontrib>Zhao, Sophia H</creatorcontrib><creatorcontrib>Boland, Genevieve M</creatorcontrib><creatorcontrib>Fadden, Riley</creatorcontrib><creatorcontrib>Sullivan, Ryan</creatorcontrib><creatorcontrib>Reynolds, Kerry L</creatorcontrib><creatorcontrib>Sise, Meghan E</creatorcontrib><collection>BMJ Journals (Open Access)</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Journal for immunotherapy of cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Meghan D</au><au>Seethapathy, Harish</au><au>Strohbehn, Ian A</au><au>Zhao, Sophia H</au><au>Boland, Genevieve M</au><au>Fadden, Riley</au><au>Sullivan, Ryan</au><au>Reynolds, Kerry L</au><au>Sise, Meghan E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rapid corticosteroid taper versus standard of care for immune checkpoint inhibitor induced nephritis: a single-center retrospective cohort study</atitle><jtitle>Journal for immunotherapy of cancer</jtitle><addtitle>J Immunother Cancer</addtitle><date>2021-04</date><risdate>2021</risdate><volume>9</volume><issue>4</issue><spage>e002292</spage><pages>e002292-</pages><issn>2051-1426</issn><eissn>2051-1426</eissn><abstract>BackgroundCurrent guidelines for treatment of immune checkpoint inhibitor (ICI)-induced nephritis are not evidence based and may lead to excess corticosteroid exposure. We aimed to compare a rapid corticosteroid taper to standard of care.MethodsRetrospective cohort study in patients with ICI-induced nephritis comparing a rapid taper beginning with 60 mg/day prednisone and tapered to 10 mg within 3 weeks to a historical control group that began 60 mg/day tapered to 10 mg within 6 weeks (standard of care). Renal recovery was defined as creatinine returning to within 1.5-fold baseline. The log-rank test compared the differences in time to renal recovery between the groups. We report rates of renal recovery at 30, 60 and 90 days, and timing and outcomes of ICI rechallenge.ResultsThirteen patients received rapid corticosteroid taper and 14 patients received standard of care. Baseline characteristics were similar between groups. The median time to ≤10 mg/day prednisone was 20 days (IQR 15–25) in the rapid-taper group compared with 38 days (IQR 30–58) in the standard-of-care group. There was no significant difference in the time to renal recovery between the groups, though numerically higher numbers of patients recovered by 30 days, 11 (85%) in the rapid-taper arm versus 6 (46%) in the standard of care arm. Exposure to other nephritis-causing medications (proton pump inhibitor or trimethoprim-sulfamethoxazole) during the corticosteroid taper was more common in the standard of care group, 9 (64%) versus rapid-taper group, 2 (15%), and was associated with longer time to renal recovery, 20 days (IQR 14–101) versus 13 days (IQR 7–34) in those that discontinued nephritis-causing medications. Fifteen (56%) of patients were rechallenged with ICIs, and only two (13%) developed recurrent nephritis.ConclusionsPatients with ICI-induced nephritis have excellent kidney outcomes when treated with corticosteroids that are tapered over 3 weeks.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>33849926</pmid><doi>10.1136/jitc-2020-002292</doi><orcidid>https://orcid.org/0000-0002-6895-5968</orcidid><orcidid>https://orcid.org/0000-0001-5344-6645</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - adverse effects Aged Aged, 80 and over Anti-inflammatory agents Antibiotics Biopsy Boston Cancer Cancer therapies Clinical/Translational Cancer Immunotherapy Cohort analysis Creatinine Drug dosages Drug Tapering Female Humans Immune Checkpoint Inhibitors - adverse effects Immunotherapy Kidney diseases Male Middle Aged Nephritis - chemically induced Nephritis - drug therapy Nephritis - immunology Patients Prednisone - administration & dosage Prednisone - adverse effects Recovery of Function Remission (Medicine) Retrospective Studies Standard of care Steroids Time Factors Treatment Outcome |
| title | Rapid corticosteroid taper versus standard of care for immune checkpoint inhibitor induced nephritis: a single-center retrospective cohort study |
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