Immune Checkpoint Inhibitors Associated Myocarditis

A multi-center registry in the US revealed that myocarditis associated with immune checkpoint inhibitors (ICI) may occur early, has a malignant course and may respond to higher doses of steroids. The initial 35 cases were diagnosed between November 2013 and July 2017, with an incidence of 1.9% and median onset of 34 days after start of ICI. 54% had no other immune-related side effects. Over a median follow-up of 102 days, 16 (46%) developed major adverse cardiac events (MACE, defined as a composite of cardiovascular death, cardiogenic shock, cardiac arrest and complete heart block); 38% of MACE had a normal ejection fraction. There was a 4-fold increase in MACE with a Troponin T of ≥1.5 ng/ml. Steroids were used in 86%; lower doses of steroids were associated with a higher troponin and a trend toward higher MACE. Source: https://www.sciencedirect.com/