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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

Intervention Mechanism of action Advantages Disadvantages Articles/cases
Steroid 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)
Infliximab 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)
Alemtuzumab 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 [8]
(total: 1)
Abatacept 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)
Plasmapheresis 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)
Tocilizumab 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)
Immuno-globulin 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)
Rituximab 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)
Tacrolimus 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)
Methotrexate 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 [40]
(total: 1)
Cyclophos-phamide 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)