Table 2

Clinical outcomes

Rapid taperStandard of care
Corticosteroid treatment, count (%) or median (IQR)
 Received intravenous pulse methylprednisolone3 (23%)6 (43%)
 Grams of methylprednisolone0.75 (0.2–1.0)0.65 (0.13–1)
 Initial daily oral prednisone dose, mg60 (60–60)60 (6–60)
 Median days at initial oral prednisone dose*7 (3–7)7 (6–8)
 Median days until≤10 mg of prednisone20 (15–25)38 (30–58)
 Received second-line immunosuppression00
Renal recovery (defined by creatinine<1.5 fold baseline)
 Renal recovery within 30 days11 (85%)6 (46%)
 Best creatinine (mg/dL) within 30 days, median (IQR)1.31 (1.13–1.45)1.49 (1.29–1.62)
 Renal recovery within 60 days11 (85%)9 (64%)
 Best creatinine within 60 days1.18 (1.02–1.34)1.35 (1.29–1.49)
 Corticosteroid refractory nephritis† at 90 days1 (8%)4 (29%)
 Steroid re-initiated or re-escalated prior to ICI-rechallenge2 (15%)2 (14%)
 Median time to renal recovery, days (IQR)11 (7–18)36 (20–100)
Rechallenge with ICI
 Rechallenged with ICI7 (54%)8 (57%)
 Median days until rechallenge (IQR)26 (15–182)135 (53–290)
 Relapse of ICI-induced nephritis after ICI rechallenge1 (14%)1 (13%)
 Relapse within another severe irAE after rechallenge‡2 (29%)3 (38%)
 Receiving prednisone at rechallenge6 (86%)7 (88%)
 Median dose of oral prednisone at rechallenge10 (3.8–10)7.5 (3.8–10)
 Experienced clinical benefit from ICI rechallenge4 (57%)4 (50%)
  • Clinical benefit from ICI rechallenge was defined as at least stable disease for >6 months.

  • *One patient received an oral methylprednisolone taper; the dose was converted to prednisone equivalent.

  • †The one patient that did not experience renal recovery at any point in the follow-up period was assigned the last follow-up date for calculating time to renal recovery. This patient had extremely low baseline creatinine (0.58 mg/dL) and her follow-up creatinine improved to 1.2 but never recovered to within 1.5-fold baseline.

  • ‡Among the patients treated with rapid taper who were rechallenged with ICIs, a new severe irAE requiring corticosteroids occurred in two patients (one colitis, one pneumonitis). Among the patients treated with standard of care corticosteroid regimens who were rechallenged with ICIs, a new severe irAE requiring corticosteroids occurred in three patients (one pneumonitis, two hepatitis).

  • ICI, immune checkpoint inhibitor; irAE, immune related adverse event.