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Kidney Week

Abstract: FR-PO182

Shorter vs. Longer Corticosteroid Duration and Recurrent Immune Checkpoint Inhibitor-Associated AKI

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Gupta, Shruti, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • García-Carro, Clara, San Carlos Clinical Hospital, Madrid, Spain
  • Sise, Meghan E., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Soler, Maria Jose, Vall d’Hebron University Hospital, Barcelona, Spain
  • Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States

Group or Team Name

  • ICPi-AKI Consortium
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 events and possibly decreased progression-free survival among patients treated with ICPis. We therefore sought to determine whether a shorter duration of corticosteroids was equally efficacious and safe as compared to a longer duration.

Methods

We used data from our previously conducted multicenter cohort study of patients diagnosed with ICPi-AKI from 29 centers across 9 countries. We examined whether a shorter duration of corticosteroids (28 days or less) versus a longer duration of corticosteroids (29-84 days) was associated with a higher rate of recurrent ICPi-AKI or death in the 30-day period following completion of corticosteroid treatment.

Results

Of 165 patients treated with corticosteroids, 56 (34%) received a shorter duration of treatment and 109 (66%) received a longer duration. Patients in these two groups were similar with respect to age, sex, race, malignancy type, and baseline kidney function. 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 (Log-rank P=0.90) (Figure A). Nadir serum creatinine in the first 14, 28, and 90 days following completion of corticosteroid treatment was similar in the shorter versus longer duration groups (P=0.40, P=0.56, and P=0.89, respectively) (Figure B).

Conclusion

A duration of corticosteroids of 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.