Impact of baseline glucocorticoids (GCs) on cardiotoxic events and myocardial damage related to immune checkpoint inhibitors: a retrospective clinical research

Immune checkpoint inhibitors (ICIs)-associated cardiotoxic events (CEs) are of increasing concern. Existing research about glucocorticoids (GCs) on immunotherapy focused on ICIs’ efficacy and patients’ outcome. The influence of GCs on ICIs-associated CEs and myocardial damage (MD) remains unknown. This single-center retrospective study included patients treated with ICIs from 2018 to 2022, with follow-up period ending on 30 June 2023. The incidence, risk factors of ICIs-associated CEs, especially MD were described. Additionally, the impact of baseline GCs was assessed by propensity score matching (PSM) to mitigate intergroup differences and ensure comparability. Among 1018 patients, 204 (20.04%) experienced ICIs-associated CEs, including 71 (6.97%) with MD. The mean follow-up time was 40.39 (95% CI 38.47–42.31) weeks. The median time to onset of MD was the shortest at 12.57 weeks (IQR 5.29–25.14). Tumor type, co-medication with platinum and angiogenesis inhibitors may be influential factors of MD. After PSM, the relative risks of CEs (OR 0.4625,95%CI 0.2514–0.7235, <i>p</i> = 0.0020) and MD (OR 0.3254, 95% CI 0.1190–0.8898, <i>p</i> = 0.0378) in GCs1 ≥ 20 mg group were both significantly lower than those in GCs1 &lt; 20 mg. GCs ≥ 20 mg during the first ICIs treatment cycle is significantly associated with the reduced risks of both ICIs-associated CEs and MD.