Short versus long corticosteroid therapy for immune checkpoint inhibitors-induced acute tubulointerstitial nephritis

Abstract Background Immune-mediated acute tubulointerstitial nephritis (ICI-AIN) is the most common form of immune-mediated renal toxicity induced by immune checkpoint inhibitors (ICIs). It has an excellent response to corticosteroids, but there is no consensus on the most suitable steroid regimen. Methods A multicentre retrospective study including 62 patients diagnosed with ICI-AIN treated with corticosteroids was conducted. Patients were categorized into two groups based on the duration of corticosteroid treatment: “short course of steroids (SCS)” (< 12 weeks) and “long course of steroids (LCS)” (≥12 weeks). The study aims to compare the efficacy and toxicity of these two regimens. Results Twenty-eight patients received SCS and 34 received LCS. Renal recovery was achieved in 89% of patients with no differences between groups (p= 1). Serum creatinine levels were also similar (1.2 mg/dL, p= 0,71) at the end of follow-up. ICI rechallenge was attempted in 18 patients, and ICI-AIN recurred in 5 (28%). Among these, four recurrences occurred in LCS patients, 67% still receiving ≥10 mg of prednisone. Steroid-related adverse events per patient-month were lower in the SCS group (0.027 vs 0.072, 95% CI: 0.20 – 0.68; p= 0.001). At 12 and 18 months, progression-free survival and overall survival were significantly better in the SCS group, even after adjusting for confounders. Conclusions SCS is an effective and safe approach for the management of ICI-AIN. It offers a comparable rate of renal recovery, fewer adverse events, and possibly more favourable oncological outcomes, compared to a prolonged regimen. Future prospective studies are warranted.