Combination of ruxolitinib and abatacept with glucocorticoids for the treatment of immune checkpoint inhibitor associated myocarditis

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ID: 323375
2026
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Abstract
Abstract Introduction and Objectives Immune checkpoint inhibitor (ICI)–related myocarditis is a rare but potentially fatal immune-related adverse event. While high-dose corticosteroids represent the cornerstone of treatment, the optimal first-line immunosuppressive strategy remains uncertain. The aim of this study was to evaluate the effectiveness of first-line combination therapy with ruxolitinib and abatacept in addition to corticosteroids in patients with ICI-related myocarditis. Methods We conducted a retrospective analysis of consecutive patients admitted to a tertiary referral center with suspected ICI-related myocarditis from August 2023 onwards. Clinical presentation, electrocardiographic findings, imaging data, treatment strategies, and in-hospital outcomes were analyzed. Results Among 26 patients with initial suspicion of ICI-related myocarditis, 3 were diagnosed with alternative conditions, and 23 were classified as having definite or probable myocarditis. Three patients only received corticosteroids: two because the involvement was mild and without electrocardiographic changes, and one due to a fulminant course resulting in death within less than 24 hours. All the other 20 patients received methylprednisolone combined with ruxolitinib, and abatacept was additionally administered in 13 patients (65%). The main presenting manifestations were myositis or myasthenic syndrome in 70%, respiratory failure in 5%, and asymptomatic cardiac troponin I elevation in 25%. Respiratory failure requiring non-invasive ventilatory support occurred in 8 patients (40%), while one patient developed cardiogenic shock. Electrocardiographic abnormalities were observed in 16 patients (80%), including ventricular arrhythmias in 4 (20%) and conduction disorders in 12 (60%). Complete atrioventricular block developed in 4 patients, leading to permanent pacemaker implantation in 3 cases. Left ventricular systolic dysfunction was present in three patients (15%). Pericardial effusion was detected in 2 patients (10%), with no cases of cardiac tamponade. Four patients (20%) died during hospitalization, one due to refractory ventricular arrhythmias. Conclusions In this cohort of patients with definite or probable ICI-related myocarditis, characterized by a high burden of arrhythmic complications, first-line combination immunosuppressive therapy with corticosteroids, ruxolitinib, and abatacept was associated with favorable in-hospital outcomes and low mortality.
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Authors E Rife Pardo, G Oristrell, N Vallejo, S Vila-Sanjuan, E Trallero, C Suarez, A Uribarri, M Vidal, I Ferreira
Journal European heart journal supplements : journal of the European Society of Cardiology
Year 2026
DOI
10.1093/eurheartjsupp/suag097.182
URL
https://doi.org/10.1093/eurheartjsupp/suag097.182
Keywords Keywords not found

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