Immune checkpoint Inhibitor related myocarditis reported through the FDA adverse event reporting system: pharmacovigilance trends in reporting and outcomes

TL;DR

This study examines trends in myocarditis cases linked to immune checkpoint inhibitors using FDA data from 2012 to 2023, finding an increase in reports but a possible decline in fatality rates.

Contribution

The study provides updated pharmacovigilance trends on ICI-related myocarditis, including fatality rates and drug-specific reporting odds ratios.

Findings

The reporting odds ratio for ICI drugs was 30.1, with individual drug RORs ranging from 12.3 to 168.5.

The overall fatality rate was 37%, with a significant decrease from 45% in 2018 to 33% in 2022.

Most reported cases were in males (62%) with a median age of 69 years.

Abstract

As the use of immune checkpoint inhibitors (ICIs) continues to expand, it is important to be mindful of rare but serious side effects such as myocarditis. Multiple analyses of adverse effect databases have demonstrated an association between ICIs and myocarditis; however, given the rapid implementation of therapeutic use, introduction of multiple new ICIs, and expanding indications, it is unclear if trends are evolving in reporting and outcomes.

We analyzed the FDA Adverse Event Reporting System to investigate the association between ICIs and myocarditis and trends in myocarditis outcomes among reports submitted between 2012 and the first quarter of 2023.

After removal of duplicate cases, 1,326 myocarditis cases were reported to the database in patients receiving ICIs. Of these, the majority of reported cases were in males (62%) and the median age was 69 years. Consistent with the increase in utilization, the number of cases reported per year increased with each passing year. The reporting odds ratio (ROR) for all ICI drugs included in the analysis was 30.1 (95% confidence interval: 28.4-32.0). RORs for the individual drugs ranged from 12.3 for durvalumab to 168.5 for nivolumab/ relatlimab. The overall fatality rate of all cases was 37%. A significant difference in fatality rate among reported cases was present when comparing outcomes in 2018 and 2022 (45% vs 33%, respectively, p=0.017).

Myocarditis continues to be associated with immune checkpoint inhibitors, with the number of reported cases increasing consistent with increasing utilization; however, the outcomes may be improving with less cases being reported as fatal.

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