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Table 2 Immunosuppressive agents used in the included studies and cases

From: Immune checkpoint inhibitor-induced myocarditis in cancer patients: a case report and review of reported cases


Mechanism of action





Multifactorial immunosuppressive

Rapid immunosuppressive effectKnown to be potent suppressor of T cell function and activity

High-dose corticosteroids increase the risk of infections, gastric ulcer, exacerbate congestive heart failure, trigger/dys-regulate diabetes

[10,11,12,13,14, 23,24,25, 27,28,29,30,31,32,33, 36, 37, 39, 44,45,46, 48, 49, 51, 52, 54,55,56,57, 59, 63, 71]

(total 38)

Antithymocyte globulin

Polyclonal antibody induces T-lymphocyte depletion via complement-dependent cell lysis

Can induce large reductions (through cell lysis) in the number of circulating T-lymphocytes

After administration the patient becomes immune-deficient for a longer period of time. Risk of anaphylactic reactions.

[16, 22, 26, 49, 56, 57, 64, 67]

(total: 11)

Mycophenolate mofetil

Inhibits the proliferation of T- and B-lymphocytes

Has a cytostatic effect on B- and T-lymphocytes

Risk of infections. Risk of reactivating hepatitis B or C, Epstein-Barr virus and Cytomegalovirus

[8, 15, 17, 21, 22, 26, 35, 54, 57, 64, 68]

(total: 14)


Monoclonal antibody inhibits tumor necrosis factor (TNF-alfa)

Inhibits cell signaling that induces inflammation

Risk of serious infections

[18, 39, 47, 50, 56, 57, 62, 65]

(total: 8)


Monoclonal antibody that binds to CD52 on the surface of mature T- and B-lymphocytes, which induces their destruction through activation of the complement system

Induces rapid T-cell depletion

Risk of inducing autoimmune diseases and infections


(total: 1)


A fusion protein that binds CD28/CD86, which modulates the co-stimulation of T-cells so they cannot be activated

Blocks the activation of T-cells

Risk of infections, risk of inducing malignancy

[9, 17]

(total: 2)


An extracorporeal therapy, which can remove immune complexes from the blood

Rapid removal of circulating immune complexes from the blood of the patient

Risk of infections

[8, 9, 17, 18, 20, 21, 34, 40, 58, 61, 65, 66]

(total: 12)


Humanized monoclonal antibody directed at the proinflammatory cytokine interleukin (IL)-6-receptor

Anti-inflammatory effect

Risk of gastrointestinal perforationRisk of infections

[7, 69]

(total: 2)


Induces inactivation of autoreactive T-cells, inactivation of B-cells, regulation and antibody production. Interferes with complement activation

Has several immunosuppressive effects

Risk of acute kidney injury and thromboembolic events

[18, 34, 38, 40,41,42,43, 53, 56, 58, 60, 65, 66, 68,69,70]

(total: 18)


Monoclonal antibody directed towards CD20 on B-cells, binding causes death of the cell and B-cell depletion

Induces depletion of B-cells

Increased infections and rare opportunistic infections, such as PML, have been reported

[8, 68]

(total: 2)


Inhibits calcineurin, which is involved in the production of IL-2. IL-2 promotes the development and proliferation of T-cells

Inhibits development and proliferation of T-cells

Risk of infections, kidney and liver toxicity and blindness

[20, 38]

(total: 2)


Antimetabolite that inhibits the enzyme dihydrofolate, which leads to a lack of tetrahydrofolate and thereby inhibits the DNA-synthesis of cells

Suppressing of the functions of T-cells

Risk of infections, pulmonary side effects and hepatotoxity


(total: 1)


Cyclophosphamide is an alkylating agent with cytostatic effect. It binds the RNA and DNA of the cell, leading to the inactivation of transcription and translation

Affects both the humoral and the cellular immune response

Bone marrow suppression

[49, 57]

(total: 2)