High-dose corticosteroid use and risk of hospitalization for infection in patients treated with immune checkpoint inhibitors - A nationwide register-based cohort study

Signe Sørup*, Bianka Darvalics, Leo Russo, Dina Oksen, Francois-Xavier Lamy, Patrice Verpillat, Khalil Aa, Sørensen Ht, Deirdre Cronin-Fenton

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Abstract

High-dose corticosteroids have been associated with increased risk of serious infection in patients with metastatic melanoma treated with immune checkpoint inhibitors targeting cytotoxic T-lymphocyte antigen 4. This potential association needs to be examined further among patients with other cancer types and for other immune checkpoint inhibitors. We examined whether receipt of high-dose corticosteroids was associated with increased rates of hospitalization for infection among 981 Danish renal, urothelial, and lung cancer patients followed from first administration of programmed death receptor 1 (PD-1)/programmed death ligand 1 (PD-L1) immune checkpoint inhibitors. Our cohort analysis was based on the information from national medical registries. During follow-up, 522 patients (53.2%) initiated treatment with high-dose corticosteroids and 317 patients (32.3%) experienced at least one hospitalization for infection. In analyses adjusted for age, sex, and previous use of chemotherapy/targeted therapy, initiation of high-dose systemic corticosteroids was associated with increased rate of hospitalization for infections (hazard ratio (HR) = 2.96, 95% confidence interval (CI) = 2.41-3.65) even in patients not receiving any chemotherapy/targeted therapy (HR = 3.66, 95% CI = 2.25-5.96). Our findings showed that high-dose corticosteroid initiation is associated with hospitalization for infection in patients treated with PD-1/PD-L1 immune checkpoint inhibitors. Clinicians and patients should be aware of this risk of infection when initiating treatment with high-dose corticosteroids.

Original languageEnglish
JournalCancer Medicine
Volume10
Issue14
Pages (from-to)4957-4963
Number of pages7
ISSN2045-7634
DOIs
Publication statusPublished - Jul 2021

Keywords

  • PD-1 immune checkpoint inhibitor
  • PD-L1 immune checkpoint inhibitor
  • corticosteroid
  • hospitalization for infection
  • CANCER-PATIENTS
  • ADVERSE EVENTS

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