Table 1 Baseline characteristics comparing patients with immune checkpoint inhibitor myocarditis treated with and without infliximab
Not Treated with Infliximab | Treated with Infliximab | p-value | |
|---|---|---|---|
N = 7 | N = 4 | ||
Baseline Patient Characteristics | |||
Age, mean (SD) | 72.7 (6.5) | 61.8 (4.6) | 0.016 |
Gender (male) | 6 (86 %) | 2 (50 %) | 0.20 |
BMI, mean (SD) | 23.4 (4.8) | 27.7 (9.8) | 0.35 |
Hypertension | 2 (29 %) | 2 (50 %) | 0.48 |
Diabetes | 1 (14 %) | 0 (0 %) | 0.43 |
Tobacco Use | 0 (0 %) | 0 (0 %) | |
Coronary Artery Disease | 1 (17 %) | 0 (0 %) | 0.39 |
Heart Failure | 2 (29 %) | 0 (0 %) | 0.24 |
Cerebral Vascular Accident | 7 (100 %) | 4 (100 %) | |
Obstructive Sleep Apnea | 7 (100 %) | 4 (100 %) | |
Chronic Kidney Disease | 2 (29 %) | 1 (25 %) | 0.90 |
Baseline Cancer Demographics | |||
Total No. of ICI doses, median (IQR) | 2.0 (1.0, 14.0) | 2.5 (1.5, 6.0) | 0.77 |
Time from ICI dose to Onset of Symptoms, Days, (median IQR) | 53.0 (21.0, 424.0) | 74.0 (52.0, 171.5) | 0.71 |
Malignancy | 0.23 | ||
Metastatic Melanoma | 1 (14 %) | 2 (50 %) | |
Metastatic RCC | 0 (0 %) | 1 (25 %) | |
Ovarian Adenocarcinoma | 0 (0 %) | 1 (25 %) | |
NSCLC | 3 (43 %) | 0 (0 %) | |
Metastatic SCC of tongue | 1 (14 %) | 0 (0 %) | |
Laryngeal SCC | 1 (14 %) | 0 (0 %) | |
DLBCL | 1 (14 %) | 0 (0 %) | |
Immune Checkpoint Inhibitor | 0.31 | ||
Nivolumab | 2 (29 %) | 3 (75 %) | |
Pembrolizumab | 4 (57 %) | 1 (25 %) | |
Darvalumab | 1 (14 %) | 0 (0 %) | |
Combined ICI (anti-CTLA-4 + anti-PD1/PDL1) | 1(14 %) | 0 (0 %) | 0.77 |
Prior Chemotherapy or Radiation | |||
Radiation | 6 (86 %) | 1 (25 %) | 0.044 |
Anthracycline | 0 (0 %) | 0 (0 %) | |
VEGF inhibitors | 0 (0 %) | 0 (0 %) | |
Myocarditis Presentation and Management | |||
Follow up time, days (mean SD) | 279.0 (219.8) | 287.2 (258.2) | 0.96 |
BNP, mean (SD) | 8562.0 (14856.4) | 11749.3 (9355.2) | 0.75 |
Admission Troponin, ng/ml (median IQR) | 0.2 (0.0, 0.6) | 0.7 (0.4, 4.8) | 0.089 |
Peak Troponin ng/ml (median IQR) | 0.2 (0.1, 0.6) | 1.0 (0.5, 4.9) | 0.13 |
Time for Troponin Normalization, days (median IQR) | 1740 (1245, 2160) | 4545 (1680, 9315) | 0.25 |
ICI Myocarditis Grade | 0.023 | ||
1 | 0 (0 %) | 0 (0 %) | |
2 | 4 (57 %) | 0 (0 %) | |
3 | 2 (29 %) | 0 (0 %) | |
4 | 1 (14 %) | 4 (100 %) | |
Clinical Presentation | |||
MACE | 1 (14 %) | 4 (100 %) | 0.006 |
Congestive Heart Failure | 4 (57 %) | 4 (100 %) | 0.12 |
Cardiogenic Shock | 0 (0 %) | 2 (50 %) | 0.039 |
Complete Heart Block | 1 (14 %) | 2 (50 %) | 0.20 |
Ventricular Tachycardia | 0 (0 %) | 4 (100 %) | < 0.001 |
Cardiac Arrest | 1 (14 %) | 1 (25 %) | 0.66 |
Echocardiogram | |||
Pre-ICI EF, mean (SD) (n = 4) | 57.5 (15.0) | 63.3 (2.9) | 0.54 |
New EF, mean (SD) | 42.5 (20.2) | 38.8 (4.8) | 0.73 |
Mitral Inflow E, cm/s (mean SD) (n = 7) | 85 (27) | 75 (31) | 0.65 |
Mitral Inflow A, cm/s (mean SD) (n = 7) | 89 (13) | 50 (9) | 0.007 |
E/A, mean (SD) (n = 7) | 0.9 (0.3) | 1.5 (0.7) | 0.16 |
Average Mitral E/e’, (mean SD) (n = 7) | 12.3 (3.0) | 12.3 (7.5) | 0.99 |
Cardiac MRI | |||
ECV, % (n = 4) | 32.0 | 35.5 | 0.65 |
Native T1 value (ms) (n = 5) | 1076 (102) | 1130 (27) | 0.53 |
Predominant LGE Pattern (n = 6) | 0.63 | ||
Sub-endocardial/Transmural | 0 | 2 | |
Sub-epicardial | 0 | 0 | |
Mid-myocardial | 2 | 2 | |
Diffuse | 0 | 0 | |
Treatment | |||
Initial Treatment on Presentation | Prednisone 1 mg/kg | IV solumedrol 1 g x3 days and infliximab 5 mg/kg | |
Prednisone Duration, days (median IQR) | 90 (60,150) | 150 (75, 300) | 0.32 |
Survival at discharge | 7 (100 %) | 4 (100 %) |