Related Experiment Video
Updated: May 5, 2026
06:07
Monitoring PD-1-Blocking Antibodies Bound to T Cells Derived from a Drop of Peripheral Blood
Published on: February 5, 2020
5.7K
Immune Checkpoint Inhibitors and Cardiotoxicity: A Comparative Meta-Analysis of Observational Studies and Randomized
Akash Sharma1,2, Grace Alexander3, Jian H Chu4
1Department of Medicine University at Buffalo-Catholic Health System Buffalo NY.
Journal of the American Heart Association
|May 18, 2024
Summary
Immune checkpoint inhibitors (ICIs) increase cardiotoxicity risk, including myocarditis and myocardial infarction, in clinical trials. However, observational studies show no increased risk, suggesting differences in diagnosis and management.
Area of Science:
- Cardiology
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) are associated with cardiotoxicity, a condition with high mortality.
- Assessing ICI cardiotoxicity risk is crucial for clinical decisions, yet data from randomized controlled trials (RCTs) and real-world observational studies (OSs) often diverge.
Purpose of the Study:
- To systematically compare the cardiotoxicity risks associated with immune checkpoint inhibitors (ICIs) in randomized controlled trials (RCTs) versus observational studies (OSs).
- To evaluate the incidence of myocarditis, pericardial disease, myocardial infarction, and stroke in patients receiving ICIs.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, Cochrane Library, and Scopus.
- Included were phase II and III RCTs and OSs reporting cardiotoxic events with immunotherapy.
- Odds ratios (ORs) were used to pool results, comparing ICIs with non-ICI therapies, following PRISMA guidelines.
Main Results:
- In 54 RCTs (N=38,264), ICI use was linked to higher risks of myocarditis (OR, 3.55), pericardial disease (OR, 2.73), and myocardial infarction (OR, 1.83) compared to non-ICI treatments.
- In 24 OSs (N=12,561,455), ICI use was not associated with myocarditis, pericardial disease, or myocardial infarction.
- Combination ICIs showed a higher risk of myocarditis than single ICI use in OSs (OR, 3.07). Stroke risk was not elevated with ICIs in RCTs.
Conclusions:
- Immune checkpoint inhibitors (ICIs) are associated with increased risks of myocarditis, pericardial disease, and myocardial infarction in RCTs, but not in OSs.
- Discrepancies between RCTs and OSs suggest potential differences in diagnostic criteria and patient management.
- Further investigation is needed to reconcile these findings and optimize the safe use of ICIs.
Related Concept Videos
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
627
Biopharmaceutical studies constitute a vital field aiming to enhance drug delivery methods and refine therapeutic approaches, drawing upon diverse interdisciplinary knowledge. In research methodologies, the choice between controlled and non-controlled studies significantly influences the study's reliability and accuracy.
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
627
01:14Myocarditis III: Medical Management
343
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
343
01:29Cardiomyopathy V: Interprofessional Care
753
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
753