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Purpose <p>Patients on immune checkpoint therapy (ICT) are at risk for neuropsychiatric events due to the use of steroids in managing immune-related adverse effects. We aimed to characterize neuropsychiatric events after the initial administration of high-dose steroids following early ICT.</p> Methods <p>We performed a retrospective, single-institution cohort study for those on ICT between 6/1/2017 and 6/1/2022 during the 6&#xa0;months after the initial administration of high-dose steroids (≥ 40&#xa0;mg/d of prednisone or equivalent glucocorticoid dose) within 7&#xa0;months from ICT compared with control patients receiving ICTs but not receiving steroids in this timeframe. The steroid group consisted of single (≤ 1&#xa0;month) and extended (&gt; 1&#xa0;month) exposure based on prescriptions. Neuropsychiatric events by proxy measures (new psychiatric diagnoses and psychiatric medications) were compared between groups using 2-sided <i>t</i>-tests and chi-square tests. Multinomial logistic regression models were used to determine group differences in neuropsychiatric events while adjusting for predefined covariates.</p> Results <p>A total of 13,465 patients were analyzed, with 3080 and 10,385 patients in the steroid and control groups, respectively. New psychiatric diagnoses were more frequent in the steroid group compared with controls (11% for single exposure and 15% for extended vs 2.5% for controls) for 1 new diagnosis. The extended steroid group had more new antipsychotic prescriptions (6.3% for single exposure and 11% for extended vs 9%, <i>p</i> &lt; 0.001) and intravenous/intramuscular haloperidol or chlorpromazine use (2.8% for single exposure and 5.5% for extended vs 2.1%, <i>p</i> &lt; 0.001).</p> Conclusion <p>Extended high-dose steroid use during early ICT was associated with an increased frequency of neuropsychiatric events, highlighting the need to educate patients and medical staff about this risk and to monitor neuropsychiatric events for early recognition and intervention in this population.</p>

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Neuropsychiatric events following high-dose steroid administration during early immune checkpoint therapy are more frequent with extended steroid exposure

  • 期刊论文

  • 发表日期：

    2025年11月8日

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  • Tamara E. Lacourt,
  • Marc C. Schubert,
  • Bilal A. Siddiqui,
  • Sumit K. Subudhi,
  • Deepti A. Chopra

摘要

Purpose

Patients on immune checkpoint therapy (ICT) are at risk for neuropsychiatric events due to the use of steroids in managing immune-related adverse effects. We aimed to characterize neuropsychiatric events after the initial administration of high-dose steroids following early ICT.

Methods

We performed a retrospective, single-institution cohort study for those on ICT between 6/1/2017 and 6/1/2022 during the 6 months after the initial administration of high-dose steroids (≥ 40 mg/d of prednisone or equivalent glucocorticoid dose) within 7 months from ICT compared with control patients receiving ICTs but not receiving steroids in this timeframe. The steroid group consisted of single (≤ 1 month) and extended (> 1 month) exposure based on prescriptions. Neuropsychiatric events by proxy measures (new psychiatric diagnoses and psychiatric medications) were compared between groups using 2-sided t-tests and chi-square tests. Multinomial logistic regression models were used to determine group differences in neuropsychiatric events while adjusting for predefined covariates.

Results

A total of 13,465 patients were analyzed, with 3080 and 10,385 patients in the steroid and control groups, respectively. New psychiatric diagnoses were more frequent in the steroid group compared with controls (11% for single exposure and 15% for extended vs 2.5% for controls) for 1 new diagnosis. The extended steroid group had more new antipsychotic prescriptions (6.3% for single exposure and 11% for extended vs 9%, p < 0.001) and intravenous/intramuscular haloperidol or chlorpromazine use (2.8% for single exposure and 5.5% for extended vs 2.1%, p < 0.001).

Conclusion

Extended high-dose steroid use during early ICT was associated with an increased frequency of neuropsychiatric events, highlighting the need to educate patients and medical staff about this risk and to monitor neuropsychiatric events for early recognition and intervention in this population.