{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:58:02Z","timestamp":1790927882409,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Pharma and Therapeutics"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>Despite the immunomodulatory mechanism of immune checkpoint inhibitors (ICIs), systemic glucocorticoids are commonly used in advanced non\u2013small cell lung cancer (NSCLC). Evidence regarding their effects on ICI outcomes is inconsistent, in part due to confounding by indication and immortal time bias. We conducted a multicenter target trial emulation to assess the association of glucocorticoid timing and dose with survival outcomes while addressing these biases. Patients with advanced NSCLC who initiated ICI therapy between 2015 and 2021 at four Korean tertiary hospitals were included. The primary endpoint was 2\u2010year overall survival (OS), with disease progression as a secondary endpoint. To minimize biases, outcomes were compared between concomitant glucocorticoid users and non\u2010users using time\u2010dependent propensity score matching. Among 1,815 eligible patients, 1,128 were matched. Hazard ratios (HRs) from the four institutions were pooled using a random\u2010effects meta\u2010analysis. Concomitant glucocorticoid use was associated with an increased risk of mortality (pooled aHR 1.36; 95% CI, 1.06\u20131.75). Early exposure within 90\u2009days of ICI initiation was associated with poorer OS (aHR 1.49; 95% CI, 1.18\u20131.87), whereas later initiation showed no association. Dose\u2010stratified analyses showed that high\u2010dose exposure (&gt;\u20091\u2009mg\/kg\/day) was associated with reduced survival (aHR 1.61; 95% CI, 1.31\u20131.99), whereas low\u2010dose exposure was not associated with adverse outcomes. After accounting for confounding by indication and time\u2010related biases, concomitant systemic glucocorticoid use during ICI therapy was associated with less favorable survival outcomes. This association was more pronounced with early and high\u2010dose exposure, underscoring the clinical importance of glucocorticoid timing and dose.<\/jats:p>","DOI":"10.1002\/cpt.70424","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T04:46:21Z","timestamp":1785905181000},"page":"1129-1141","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early and High\u2010Dose Glucocorticoid Use and Survival in Advanced\n                    <scp>NSCLC<\/scp>\n                    Receiving Immune Checkpoint Inhibitors: A Multicenter Target Trial Emulation"],"prefix":"10.1002","volume":"120","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7348-3297","authenticated-orcid":false,"given":"Da Eun","family":"Lee","sequence":"first","affiliation":[{"name":"College of Pharmacy Seoul National University  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5191-4184","authenticated-orcid":false,"given":"Geunho","family":"Lim","sequence":"additional","affiliation":[{"name":"College of Pharmacy Seoul National University  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9178-8785","authenticated-orcid":false,"given":"Minoh","family":"Ko","sequence":"additional","affiliation":[{"name":"College of Pharmacy Seoul National University  Seoul Republic of Korea"},{"name":"College of Pharmacy Daegu Catholic University  Gyeongsan\u2010si Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7087-7275","authenticated-orcid":false,"given":"Mari","family":"Kim","sequence":"additional","affiliation":[{"name":"College of Pharmacy Seoul National University  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5896-1645","authenticated-orcid":false,"given":"Ji Sun","family":"Chun","sequence":"additional","affiliation":[{"name":"College of Pharmacy Seoul National University  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8161-321X","authenticated-orcid":false,"given":"Borim","family":"Lee","sequence":"additional","affiliation":[{"name":"College of Pharmacy Seoul National University  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4064-4199","authenticated-orcid":false,"given":"Miso","family":"Kim","sequence":"additional","affiliation":[{"name":"Seoul National University Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4586-5062","authenticated-orcid":false,"given":"Kwangsoo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Transdisciplinary Medicine Seoul National University Hospital  Seoul Republic of Korea"},{"name":"Department of Medicine, College of Medicine Seoul National University  Seoul Republic of Korea"},{"name":"Center for Data Science, Healthcare AI Research Institute Seoul National University Hospital  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5244-4592","authenticated-orcid":false,"given":"Byung Kwan","family":"Choi","sequence":"additional","affiliation":[{"name":"Pusan National University Hospital  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9992-6273","authenticated-orcid":false,"given":"Jeongmin","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Seoul National University Bundang Hospital  Seongnam\u2010si, Gyeonggi\u2010do Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3741-5168","authenticated-orcid":false,"given":"Jin Hyoung","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul St. Mary's Hospital The Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4045-0036","authenticated-orcid":false,"given":"Taehoon","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics, College of Medicine the Catholic University of Korea  Seoul 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