ArticleSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2025
Neuropsychiatric events following high-dose steroid administration during early immune checkpoint therapy are more frequent with extended steroid exposure.
Article in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePatients 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.
methodsWe 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.
resultsA 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).
conclusionExtended 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.
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