# Corticosteroid Taper Duration and Relapse Rate in Immune Checkpoint Inhibitor-Induced Pneumonitis: A Meta-Analysis

## TL;DR

A meta-analysis finds that about 25% of patients with immune checkpoint inhibitor-induced pneumonitis relapse after corticosteroid treatment, with shorter tapers linked to higher recurrence.

## Contribution

This study is the first to meta-analyze corticosteroid taper duration and relapse risk in immune checkpoint inhibitor-induced pneumonitis.

## Key findings

- The pooled relapse rate after corticosteroid therapy was 25.8%.
- Fixed six-week tapers were associated with significantly higher relapse odds compared to variable or extended tapers.
- Extended tapers (12-17 weeks) were often needed for stable remission in high-risk cases.

## Abstract

Immune checkpoint inhibitor-induced pneumonitis is a serious immune-related adverse event managed primarily with systemic corticosteroids, yet the optimal taper duration needed to prevent relapse remains uncertain. High rates of recurrence during or shortly after taper completion continue to complicate clinical care. This systematic review and meta-analysis evaluate the pooled relapse rate following corticosteroid therapy and compare outcomes between fixed short-term tapers and individualized or longer taper strategies.

A systematic search of the published literature identified studies reporting quantifiable relapse events after corticosteroid taper for pneumonitis. Six cohorts from four studies, totaling 296 patients, met eligibility criteria. The pooled relapse proportion (estimated event rate) was calculated using a random-effects model with logit transformation. Comparative analysis between taper strategies was performed using a fixed-effects model, and sensitivity analyses were conducted to evaluate robustness.

The pooled relapse rate was 25.8%, indicating that approximately one in four patients experienced recurrence after corticosteroid treatment. Fixed six-week taper cohorts demonstrated significantly higher odds of relapse compared with variable or extended taper regimens. Sensitivity analysis, which excluded a low-event cohort, confirmed this association and reduced heterogeneity. Qualitative synthesis showed that certain clinical features, including the organizing pneumonia radiographic pattern and pneumonitis occurring after durvalumab therapy, frequently required tapers extending beyond twelve to seventeen weeks to achieve stable remission.

Approximately one quarter of patients treated for immune checkpoint inhibitor-induced pneumonitis experience relapse after corticosteroid therapy. Fixed short-term tapers are associated with significantly higher recurrence risk compared with individualized or longer taper strategies. These findings support a risk-stratified approach to taper duration, emphasizing the need for extended tapers in higher-risk clinical scenarios while monitoring for steroid-related adverse effects.