Intravenous immunoglobulin combined with glucocorticoids for immune checkpoint inhibitor-induced fulminant myocarditis: a retrospective cohort study
D Wang, Z Zhou, W HeAbstract
Background/Introduction
Immune checkpoint inhibitors (ICIs), despite their oncological benefits, can cause severe immune-related adverse events such as fulminant myocarditis, which carries a mortality rate up to 50%. Although corticosteroids are the standard first-line treatment for ICI-induced myocarditis, associated mortality remains high.
Purpose
This study aimed to investigate whether the addition of intravenous immunoglobulin (IVIG) to standard intravenous methylprednisolone (MP) improves outcomes in patients with ICI-induced fulminant myocarditis.
Methods
We conducted a retrospective cohort study at a single center between January 2017 and November 2025. Patients clinically diagnosed with ICI-induced fulminant myocarditis were divided into two groups based on treatment received: MP alone (n=7) and MP+IVIG (n=11). The primary outcome was 90-day major adverse cardiovascular event (MACE)-free survival, with MACE defined as cardiovascular death or myocarditis recurrence requiring rehospitalization. Kaplan-Meier survival analysis and log-rank tests were used for comparisons.
Results
Kaplan-Meier analysis demonstrated significantly improved 90-day MACE-free survival in the MP+IVIG group compared to the MP alone group (log-rank P=0.017). The MACE rate was 71.4% (5/7) with a mean time to first MACE of 5 ± 2 days in the MP group versus 27.3% (3/11) with a mean time to event of 10 ± 3 days in the MP+IVIG group.
Conclusion(s)
In this retrospective study, the addition of IVIG to corticosteroid therapy was associated with significantly improved 90-day MACE-free survival in patients with ICI-induced fulminant myocarditis. These findings support the potential therapeutic benefit of this immunomodulatory combination and warrant further prospective investigation.Figure 1