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Treatment of corticosteroid refractory immune checkpoint inhibitor myocarditis with Infliximab: a case series

BACKGROUND: Glucocorticoid treatment remains the cornerstone of therapy for immune checkpoint inhibitor (ICI) myocarditis, but data supporting the use of additional immunotherapy for steroid refractory cases remains limited. We investigate the safety and efficacy of infliximab in patients with ICI m...

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Autores principales: Zhang, Robert S., Padegimas, Allison, Murphy, Kathleen M., Evans, Peter T., Peters, Carli J., Domenico, Christopher M., Vidula, Mahesh K., Mather, Paul J., Cevasco, Marisa, Cohen, Roger B., Carver, Joseph R., O’Quinn, Rupal P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008661/
https://www.ncbi.nlm.nih.gov/pubmed/33785062
http://dx.doi.org/10.1186/s40959-021-00095-x
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author Zhang, Robert S.
Padegimas, Allison
Murphy, Kathleen M.
Evans, Peter T.
Peters, Carli J.
Domenico, Christopher M.
Vidula, Mahesh K.
Mather, Paul J.
Cevasco, Marisa
Cohen, Roger B.
Carver, Joseph R.
O’Quinn, Rupal P.
author_facet Zhang, Robert S.
Padegimas, Allison
Murphy, Kathleen M.
Evans, Peter T.
Peters, Carli J.
Domenico, Christopher M.
Vidula, Mahesh K.
Mather, Paul J.
Cevasco, Marisa
Cohen, Roger B.
Carver, Joseph R.
O’Quinn, Rupal P.
author_sort Zhang, Robert S.
collection PubMed
description BACKGROUND: Glucocorticoid treatment remains the cornerstone of therapy for immune checkpoint inhibitor (ICI) myocarditis, but data supporting the use of additional immunotherapy for steroid refractory cases remains limited. We investigate the safety and efficacy of infliximab in patients with ICI myocarditis who are refractory to corticosteroids. Additionally, we highlight the importance of a multi-disciplinary approach in the care for these complex patients. METHODS: We retrospectively identified consecutive patients who developed ICI myocarditis at our institution between January 2017 and January 2020. Baseline characteristics, laboratory data and clinical outcomes were compared between patients who received infliximab and those who did not. RESULTS: Of a total of 11 patients who developed ICI myocarditis, 4 were treated with infliximab. Aside from age, there were no significant differences in baseline patient characteristics between the two groups including total number of ICI doses received and duration from initial ICI dose to onset of symptoms. The time to troponin normalization was 58 vs. 151.5 days (p = 0.25). The duration of prednisone taper was longer in the infliximab group (90 vs. 150 days p = 0.32). All patients survived initial hospital admission. Over a median follow-up period of 287 days, two of the 4 patients died from sepsis 2 and 3 months after initial treatment of their myocarditis; one of these patients was on a steroid taper and the other patient had just completed a steroid taper. CONCLUSIONS: Infliximab, despite its black box warning in patients with heart failure, may be a safe and effective treatment for ICI myocarditis.
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spelling pubmed-80086612021-03-31 Treatment of corticosteroid refractory immune checkpoint inhibitor myocarditis with Infliximab: a case series Zhang, Robert S. Padegimas, Allison Murphy, Kathleen M. Evans, Peter T. Peters, Carli J. Domenico, Christopher M. Vidula, Mahesh K. Mather, Paul J. Cevasco, Marisa Cohen, Roger B. Carver, Joseph R. O’Quinn, Rupal P. Cardiooncology Research BACKGROUND: Glucocorticoid treatment remains the cornerstone of therapy for immune checkpoint inhibitor (ICI) myocarditis, but data supporting the use of additional immunotherapy for steroid refractory cases remains limited. We investigate the safety and efficacy of infliximab in patients with ICI myocarditis who are refractory to corticosteroids. Additionally, we highlight the importance of a multi-disciplinary approach in the care for these complex patients. METHODS: We retrospectively identified consecutive patients who developed ICI myocarditis at our institution between January 2017 and January 2020. Baseline characteristics, laboratory data and clinical outcomes were compared between patients who received infliximab and those who did not. RESULTS: Of a total of 11 patients who developed ICI myocarditis, 4 were treated with infliximab. Aside from age, there were no significant differences in baseline patient characteristics between the two groups including total number of ICI doses received and duration from initial ICI dose to onset of symptoms. The time to troponin normalization was 58 vs. 151.5 days (p = 0.25). The duration of prednisone taper was longer in the infliximab group (90 vs. 150 days p = 0.32). All patients survived initial hospital admission. Over a median follow-up period of 287 days, two of the 4 patients died from sepsis 2 and 3 months after initial treatment of their myocarditis; one of these patients was on a steroid taper and the other patient had just completed a steroid taper. CONCLUSIONS: Infliximab, despite its black box warning in patients with heart failure, may be a safe and effective treatment for ICI myocarditis. BioMed Central 2021-03-30 /pmc/articles/PMC8008661/ /pubmed/33785062 http://dx.doi.org/10.1186/s40959-021-00095-x Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Zhang, Robert S.
Padegimas, Allison
Murphy, Kathleen M.
Evans, Peter T.
Peters, Carli J.
Domenico, Christopher M.
Vidula, Mahesh K.
Mather, Paul J.
Cevasco, Marisa
Cohen, Roger B.
Carver, Joseph R.
O’Quinn, Rupal P.
Treatment of corticosteroid refractory immune checkpoint inhibitor myocarditis with Infliximab: a case series
title Treatment of corticosteroid refractory immune checkpoint inhibitor myocarditis with Infliximab: a case series
title_full Treatment of corticosteroid refractory immune checkpoint inhibitor myocarditis with Infliximab: a case series
title_fullStr Treatment of corticosteroid refractory immune checkpoint inhibitor myocarditis with Infliximab: a case series
title_full_unstemmed Treatment of corticosteroid refractory immune checkpoint inhibitor myocarditis with Infliximab: a case series
title_short Treatment of corticosteroid refractory immune checkpoint inhibitor myocarditis with Infliximab: a case series
title_sort treatment of corticosteroid refractory immune checkpoint inhibitor myocarditis with infliximab: a case series
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008661/
https://www.ncbi.nlm.nih.gov/pubmed/33785062
http://dx.doi.org/10.1186/s40959-021-00095-x
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