A systematic review and meta-analysis found that the rate of cardiovascular adverse events (CVAEs) and/or myocarditis in patients treated with immune checkpoint inhibitors (ICIs) was low, although monitoring and management strategies are still needed.
The incidence of CVAEs induced by anti-programmed cell death 1 and/or programmed cell death ligand 1 was 0.80% (95% CI, 0%-1.66%) among 83,315 patients from 589 trials. Cemiplimab (Libtayo) was linked to a higher risk for CVAEs, while the incidence after ipilimumab (Yervoy) treatment was 1.07% (95% CI, 0%-2.58%).
The incidence of myocarditis was significantly higher after treatment with dual ICIs, but not higher with ICI combination with chemotherapy, dual ICIs, or tyrosine kinase inhibitors. Mortality associated with myocarditis was observed in 83 of 220 (37.7%) patients.
Researchers analyzed data from 40 patients with myocarditis, suggesting that systematic screening for respiratory muscle involvement, active ventilation, prompt use of abatacept (Orencia), and addition of ruxolitinib (Jakafi) may decrease mortality rates.
“Early recognition, ICI therapy cessation, prompt initiation of corticosteroid therapy, and escalation of therapy are all crucial elements for achieving optimal outcomes,” the study authors wrote.
The primary limitations were lack of individual patient level meta-analyses and most studies reporting on treatment-related adverse events and/or immune-related adverse events, limiting examination of cardiac parameters. Prospective trials or registrations of treatments and outcomes are warranted to establish evidence-based monitoring and management strategies for ICI-induced myocarditis.