June 15, 2020CirculationOpen Access

Major Adverse Cardiovascular Events and the Timing and Dose of Corticosteroids in Immune Checkpoint Inhibitor–Associated Myocarditis

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Why the study?

While corticosteroids are the cornerstones of treatment for immune checkpoint inhibitor-associated myocarditis, data to guide their dose and timing are lacking.

Does higher dose and earlier initiation of corticosteroids reduce major cardiovascular events in patients with immune checkpoint inhibitor-associated myocarditis?

Population

143 patients with ICI myocarditis diagnosed between 2013 and 2019

Comparison

Different initial corticosteroid doses and timing of initiation

Design

International registry-based study

Authors

LZLili ZhangGeneral Cardiology DZDaniel A. ZlotoffCardio-Oncology MAMagid AwadallaMater Misericordiae University Hospital

Discussion

Member takes

Implication

Earlier high-dose steroids were associated with lower MACE; leaves open optimal regimen pending randomized trials.

Structured PICO

Does higher dose and earlier initiation of corticosteroids reduce major cardiovascular events in patients with immune checkpoint inhibitor-associated myocarditis?

Population

143 patients with immune checkpoint inhibitor (ICI) myocarditis diagnosed between 2013 and 2019 from an international registry, mean age 67±13 years, 29% women.

Intervention

Corticosteroids (methylprednisolone, prednisone, hydrocortisone, or dexamethasone) at varying initial doses (low <60mg, intermediate 60-500mg, high >500mg methylprednisolone equivalent) and timing of initiation (within 24 hours, 24-72 hours, >72 hours).

Comparator

Different doses (low, intermediate, high) and timing (within 24h, 24-72h, >72h) of corticosteroid initiation compared against each other.

Outcome

Major cardiovascular events (MACE), a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and hemodynamically-significant complete heart block.composite

In patients with immune checkpoint inhibitor-associated myocarditis, early initiation (within 24 hours) of high-dose corticosteroids is associated with significantly improved cardiovascular outcomes.

Cite This Study

Zhang et al. (2020) studied this question.

synapsesocial.com/papers/6a7101f3febe604dd709bf39 https://doi.org/10.1161/circulationaha.119.044703

Topics

Myocarditis COVID-19 cardiovascular

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Major Adverse Cardiovascular Events and the Timing and Dose of Corticosteroids in Immune Checkpoint Inhibitor–Associated Myocarditis

Discussion

Member takes

Implication

Structured PICO

Cite This Study

Topics

Major Adverse Cardiovascular Events and the Timing and Dose of Corticosteroids in Immune Checkpoint Inhibitor–Associated Myocarditis

Discussion

Member takes

Implication

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider