Key result
Adding IVIG to methylprednisolone is linked to ~44-point lower 90-day MACE in ICI fulminant myocarditis.
Why the study?
Mortality from immune checkpoint inhibitor-induced fulminant myocarditis remains high despite standard first-line corticosteroid treatment, and whether adding intravenous immunoglobulin to intravenous methylprednisolone improves outcomes was uncertain.
Does the addition of intravenous immunoglobulin to standard intravenous methylprednisolone improve 90-day MACE-free survival in patients with immune checkpoint inhibitor-induced fulminant myocarditis?
Cohort (n=18)
No
Does the addition of intravenous immunoglobulin to standard intravenous methylprednisolone improve 90-day MACE-free survival in patients with immune checkpoint inhibitor-induced fulminant myocarditis?
Adding intravenous immunoglobulin to standard corticosteroid therapy was associated with significantly improved 90-day MACE-free survival in patients with immune checkpoint inhibitor-induced fulminant myocarditis.
May support adjunctive IVIG with methylprednisolone in ICI-fulminant myocarditis; hypothesis-generating and requires randomized confirmation.
Background/Introduction Immune checkpoint inhibitors (ICIs), despite their oncological benefits, can cause severe immune-related adverse events such as fulminant myocarditis, which carries a mortality rate up to 50%. Although corticosteroids are the standard first-line treatment for ICI-induced myocarditis, associated mortality remains high. Purpose This study aimed to investigate whether the addition of intravenous immunoglobulin (IVIG) to standard intravenous methylprednisolone (MP) improves outcomes in patients with ICI-induced fulminant myocarditis. Methods We conducted a retrospective cohort study at a single center between January 2017 and November 2025. Patients clinically diagnosed with ICI-induced fulminant myocarditis were divided into two groups based on treatment received: MP alone (n=7) and MP+IVIG (n=11). The primary outcome was 90-day major adverse cardiovascular event (MACE)-free survival, with MACE defined as cardiovascular death or myocarditis recurrence requiring rehospitalization. Kaplan-Meier survival analysis and log-rank tests were used for comparisons. Results Kaplan-Meier analysis demonstrated significantly improved 90-day MACE-free survival in the MP+IVIG group compared to the MP alone group (log-rank P=0.017). The MACE rate was 71.4% (5/7) with a mean time to first MACE of 5 ± 2 days in the MP group versus 27.3% (3/11) with a mean time to event of 10 ± 3 days in the MP+IVIG group. Conclusion(s) In this retrospective study, the addition of IVIG to corticosteroid therapy was associated with significantly improved 90-day MACE-free survival in patients with ICI-induced fulminant myocarditis. These findings support the potential therapeutic benefit of this immunomodulatory combination and warrant further prospective investigation.
No takes yet. Share an insight, caveat, or question.
Wang et al. (2026) conducted a cohort in Immune checkpoint inhibitor-induced fulminant myocarditis (n=18). Intravenous immunoglobulin plus methylprednisolone vs. Methylprednisolone alone was evaluated on 90-day major adverse cardiovascular event (MACE)-free survival (MACE defined as cardiovascular death or myocarditis recurrence requiring rehospitalization) (p=0.017). Adding IVIG to methylprednisolone improved 90-day MACE-free survival vs methylprednisolone alone in ICI-induced fulminant myocarditis (MACE 27.3% vs 71.4%; log-rank P=0.017).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: