CTLA4 and autoimmune disease: Nevertheless, some variables have been associated with a higher risk of develop severe side effects, such as patient sex, a history of autoimmune disease, previous treatment with anti-CTLA-4 inhibitors, kidney failure, treatment with glucocorticoid previous to the initiation of immunotherapy and the use of combined therapy with anti-CTLA-4 and anti-PD-1 [97,98].