Case Series of Steroid-Resistant Immune Checkpoint Inhibitor Associated Myocarditis: A Comparative Analysis of Corticosteroid and Tofacitinib Treatment

• DOI: 10.3389/fphar.2021.770631
• Publication Date: 2021-12-06T06:50:23Z
• Authors: Cong Wang; Jinyi Lin; Yan Wang; David H. Hsi; Jiahui Chen; Tianshu Liu; Yuhong Zhou; Zhenggang Ren; Zhaochong Zeng; Leilei Cheng; Junbo Ge
• Keywords: Pharmacology; corticosteroid; 03 medical and health sciences; tofacitinib; 0302 clinical medicine; cardiotoxicity; immune checkpoint inhibitor; Therapeutics. Pharmacology; RM1-950; myocarditis; 3. Good health

Background: Immune checkpoint inhibitor (ICI)-associated myocarditis is an uncommon and potentially fatal immune-related adverse event (irAE). Although corticosteroids are recommended as the first-line treatment by current guidelines, patients still have variable responses to it, guidelines vary significantly in terms of strategies. Objectives: In this study, we performed a retrospective analysis ICI-associated our hospital propose new comparative aid individualized treatment. Methods: We reviewed detailed records 24 with confirmed from July 1, 2019, April 2021. all cases study received initial corticosteroid according different were observed during process subsequent tapering. Basing on troponin cardiac T rebound tapering, classification that included two subgroups: corticosteroid-sensitive (n = 8) corticosteroid-resistant group 16). Results: Compared patients, larger doses corticosteroid, longer period treatment, higher mortality rate found patients. Corticosteroid-resistant characterized more prominent ptosis, muscle weakness, elevated biomarkers, creatine kinase, hepatic enzymes levels than Tofacitinib (5 mg twice day) was used 11 seven recovered myocarditis, showing promising therapeutic effect. Conclusion: Our responsiveness may help clinicians apply high-risk cohort. addition, tofacitinib could provide clinical benefits when early option for myocarditis.