Analysis of 88 cases of immune myocarditis due to immune checkpoint inhibitors
OBJECTIVE To explore the clinical features,treatments,pathogenic mechanisms and preventive measures of myocarditis due to immune checkpoint inhibitors(ICIs)and provide reference for clinical safe dosing.METHODS Through searching marketed ICIs in combination with"myocarditis",case reports on immune myocarditis induced by ICIs were retrieved from the databases of China National Knowledge Infrastructure(CNKI),Wanfang and PubMed.RESULTS A total of 84 articles and 88 cases were collected.Pembrolizumab was the most commonly reported,followed by sintilimab and camrelizumab.Average age was(64.33±9.84)year and elders predominated.There were 63 males(71.6％)with a mortality rate of 21.6％.The most common clinical symptoms were dyspnea or tachypnea(44.3％,39/88).Most symptoms occurred after 1-2 cycles of medication(81.8％,72/88)and over 90％of them exhibited elevated levels of cardiac biomarkers.Among 84 cases(95.5％)on glucocorticoid therapy,the symptoms of 67 cases(79.8％)improved.And treatments with other immunosuppressants,plasma exchange,implanted pacemaker or extracorporeal membrane oxygenation(ECMO)could further improve clinical symptoms.CONCLUSION ICIS-induced immune myocarditis is predominant in elderly males and clinical symptoms are non-specific.Glu-cocorticoid therapy is effective.And immunosuppressants,plasma exchange,implanted pacemaker and ECMO may improve clini-cal symptoms and survival rate.The mortality rate of ICIS-induced immune myocarditis remains high so that clinicians should raise a high alert.
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