What question did this study set out to answer?

To systematically evaluate clinical characteristics, severity, and therapeutic strategies for immune checkpoint inhibitor–associated myocarditis using published individual case reports.

October 9, 2023Frontiers in ImmunologyOpen Access

Immune checkpoint inhibitor–associated myocarditis: a systematic analysis of case reports

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Why the study?

Immune checkpoint inhibitor therapy can cause cardiovascular toxicities such as myocarditis, but no prospective trials have focused on its optimized management.

Does discontinuation of ICIs and glucocorticoid administration improve outcomes in patients with ICI-associated myocarditis?

Population

106 patients with ICI-associated myocarditis from 113 publications

Design

Systematic analysis of case reports and series

Authors

CWCaie WangShenyang Pharmaceutical University ZZZhen ZhangShenzhen Center for Disease Control and Prevention LYLukui YangFirst Affiliated Hospital of Henan University of Science and Technology

Discussion

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Implication

Glucocorticoids and ICI discontinuation merit consideration in ICI-myocarditis; extends observational data but high mortality leaves optimal strategies open.

Key Points

To systematically evaluate clinical characteristics, severity, and therapeutic strategies for immune checkpoint inhibitor–associated myocarditis using published individual case reports.
Conducted a systematic search on the PubMed database for case reports and case series published between January 2018 and May 2023.
Identified and analyzed clinical variables from 113 publications covering N=106 patients with immune checkpoint inhibitor–associated myocarditis.
Life-threatening myocarditis occurred in 53.8% of cases, with 35.8% classified as severe (Grade 3) and 23.6% classified as life-threatening (Grade 4).
Higher rates of clinical improvement occurred with ICI discontinuation (58.8% vs. 32.1%), glucocorticoid administration (30% vs. 22%), and favorable tumor response (72.7% vs. 53.9%).
Management of Grade 3–4 cases required ICI cessation combined with high-dose glucocorticoids, plasma exchange, and life support, with ICI rechallenge remaining feasible after recovery.

Structured PICO

Does discontinuation of ICIs and glucocorticoid administration improve outcomes in patients with ICI-associated myocarditis?

Population

116 patients with immune checkpoint inhibitor (ICI)-associated myocarditis from published case reports and case series

Intervention

Management strategies including discontinuation of ICIs, glucocorticoids, chemical drugs, plasma exchange, and life support

Outcome

Myocarditis outcomes (recovery, improvement, or death)safety

In patients with ICI-associated myocarditis, discontinuation of ICIs and administration of glucocorticoids are associated with higher rates of clinical improvement, though mortality remains high.

Limitations

case reports are inherently subjective, which provide a non-random sample, and often do not allow for causal inferences
publication bias was not entirely ruled out, and mild cases could have been under-reported
some detailed information on risk factors, diagnostics or management of myocarditis could be missing
patients selected for re-challenge of ICIs were probably those in better clinical condition
the sample size included in this article was limited and relied on the literature of a small collection of case reports which was not allowed for a more comprehensive quantitative analysis

Cite This Study

Wang et al. (2023) studied this question.

synapsesocial.com/papers/6a7e22114bd90feed65d799b https://doi.org/10.3389/fimmu.2023.1275254

Topics

Myocarditis

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Implication

Glucocorticoids and ICI discontinuation merit consideration in ICI-myocarditis; extends observational data but high mortality leaves optimal strategies open.

Immune checkpoint inhibitor–associated myocarditis: a systematic analysis of case reports

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Immune checkpoint inhibitor–associated myocarditis: a systematic analysis of case reports

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider