Immune checkpoint inhibitor therapy was associated with cardiac immune-related adverse events in 3.1% of patients on monotherapy and 5.8% on dual therapy, compared to 2.5% with chemotherapy alone.
Meta-Analysis (n=4,751)
What is the incidence and mortality of cardiac immune-related adverse events in patients treated with immune checkpoint inhibitors?
Immune checkpoint inhibitors are associated with a low incidence of cardiac adverse events, primarily myocarditis, but these events carry a high mortality rate, with dual therapy posing the highest risk.
Absolute Event Rate: 3.1% vs 2.5%
AIMS: This study aimed to estimate the incidence of cardiac immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitors (ICIs). METHODS AND RESULTS: First, we performed an ICI pharmacovigilance analysis, finding 4.2% of cardiac disorders, including myocarditis, for anti-CTLA-4, anti-PD-1, and anti-PD-L1 therapies. Patients treated with anti-PD-1 antibodies presented a greater number of cardiac adverse events (AEs) than those treated with anti-CTLA-4 (69.4% vs. 20%). Then, we analysed the incidence and characteristics of cardiac irAEs in 1265 papers published prior to 31 August 2020. Of the 4751 patients studied, 1.3% presented cardiac irAEs, with myocarditis being the most frequent (50.8%); 15 patients died (24.6%) due to cardiac irAEs. Finally, we conducted a meta-analysis to determine cardiac irAEs in randomized clinical trials, identified through a systematic search from the ClinicalTrials.gov database, finding an incidence of 3.1% for ICI monotherapies, 5.8% for dual ICI therapies, 3.7% (irAEs/AEs) for ICIs plus chemotherapy, and cardiac AEs were reported in 2.5% of patients treated solely with chemotherapy. CONCLUSIONS: Our study provides precise data for the incidence of cardiac irAEs among patients using ICIs, where despite its low incidence, the high rate of mortality is an important issue to consider. ICIs induce mainly myocarditis at the first doses, and dual therapies seem to provoke higher rates of cardiac irAEs than monotherapies or ICIs plus chemotherapy.
Rubio‐Infante et al. (Thu,) conducted a meta-analysis in Patients treated with immune checkpoint inhibitors (ICIs) (n=4,751). Immune checkpoint inhibitors (ICIs) vs. Chemotherapy was evaluated on Incidence of cardiac immune-related adverse events (irAEs). Immune checkpoint inhibitor therapy was associated with cardiac immune-related adverse events in 3.1% of patients on monotherapy and 5.8% on dual therapy, compared to 2.5% with chemotherapy alone.