[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-344342-105":3,"detail-sidebar-cat-0-en-105":80,"doc-detail-344342-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","myocarditis-in-patients-starting-combination-checkpoint-inhibitor-therapy-immune-related-cardiovascular-risk-in-real-world-evidence","Myocarditis in Patients Starting Combination Checkpoint Inhibitor Therapy - Immune-related cardiovascular risk in real-world evidence","","Immune checkpoint inhibitor therapy improves cancer outcomes but increases immune-related adverse events, particularly cardiovascular toxicity. This pharmacoepidemiology study used U.S. commercial medical and pharmacy claims (2011–2022) to compare dual concurrent immune checkpoint inhibitor therapy versus single-agent therapy for cancer patients. In 53,018 patients, myocarditis occurred in 0.3% overall: 0.7% with combination therapy and 0.2% with monotherapy, with higher risks and no difference in heart failure. Most myocarditis cases appeared within the first 6 months.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/research-report/","Research & Report",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/myocarditis-in-patients-starting-combination-checkpoint-inhibitor-therapy-immune-related-cardiovascular-risk-in-real-world-evidence/344342/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/myocarditis-in-patients-starting-combination-checkpoint-inhibitor-therapy-immune-related-cardiovascular-risk-in-real-world-evidence/344342.png","ImageObject",300,407,{"name":42,"@type":43},"Theodora","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-24","2026-09-22",true,{"@type":52,"interactionType":53,"userInteractionCount":22},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What was the study objective regarding immune checkpoint inhibitor therapy?","Question",{"text":62,"@type":63},"To investigate the incidence of myocarditis in relation to using dual concurrent immune checkpoint inhibitors versus single immune checkpoint inhibitors.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"How did the myocarditis risk compare between combination and monotherapy?",{"text":67,"@type":63},"Myocarditis occurred more often with combination therapy (0.7%) than with monotherapy (0.2%), with a higher risk ratio reported (3.12) and an adjusted hazard ratio of 2.38.",{"name":69,"@type":60,"acceptedAnswer":70},"Did the study find a difference in heart failure risk?",{"text":71,"@type":63},"No difference in the risk of heart failure was found between combination and single therapy.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},344342,1790240864,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},7,"Healthcare",40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":112,"slug":113},8,30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":111,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":22,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":111,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":117},687197207919,"https://ap-avatar.wpscdn.com/avatar/a000253d6f5f7c60be?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779446848396160552","Journal of the American Heart Association  \nORIGINAL RESEARCH  \n\n| Myocarditis in Patients Starting Combination Checkpoint Inhibitor Therapy: Analysis of a Commercial Claims Database\u003Cbr>Alistair C. Lindsay, MBChB, MPH, DPhil; Alexander M. Walker  , MD, DrPH; Sebastian Schneeweiss  , MD, ScD\u003Cbr>BACKGROUND: Immune checkpoint inhibitors have improved the clinical outcomes of several cancers but have also been associated with a greater risk of immune-related adverse effects, especially when combined. The objective of this study was to investigate the incidence of myocarditis in relation to the use of dual concurrent versus single immune checkpoint inhibitors therapies.\u003Cbr>METHODS AND RESULTS: A cohort study was conducted using medical and pharmacy claims data (2011–2022) from a large US commercial insurer. Cox regression quantified the comparative risks of myocarditis or heart failure in patients with cancer receiving treatment with combination therapy (nivolumab and ipilimumab) in comparison to taking a single immune checkpoint inhibitor only. Mean follow-up time in 53 018 patients was 226 days (interquartile range, 93–495 days) . There were 148 cases of myocarditis (0 .3%), 33 (0 .7%) in patients on combination therapy, and 115 (0 .2%) in patients on monotherapy. The risk of myocarditis per 1000 patients was 7.40 in the combination therapy group and 2.37 in the monotherapy group (risk ratio, 3.12 [95% CI, 2.12–4.60]) . Using multivariable regression analysis, the hazard ratio for myocarditis in the combination therapy group was 2.38 (1.57–3.63) . No difference in the risk of heart failure was found between combination and single therapy.\u003Cbr>CONCLUSIONS: Therapy with 2 immune checkpoint inhibitors was associated with an increased risk of myocarditis compared with monotherapy, with most cases occurring in the first 6 months of therapy.\u003Cbr>Key Words: cardio-oncology ■ checkpoint inhibitor ■ heart failure ■ myocarditis ■ real-world evidence |  |\n| --- | --- |\n| Immuno-oncology drugs boost the ability of the im\u003Cbr>mune system to attack tumor cells. Prominent mem\u003Cbr>bers of the class are immune checkpoint inhibitors (ICIs), which block inhibitory proteins on the surfaces of T cells and target cells and, in doing so, activate cytotoxic T cells.1,2\u003Cbr>First introduced in 2011, several ICIs have entered clinical practice, and the use of these drugs has expanded to 24 different types of cancer. ICIs have revolutionized the treatment of these cancers by achieving remarkable improvements in overall survival rates and long-term disease control. | Owing to the aberrant activation of autoimmune T cells, therapeutic blockade of immune checkpoints can also precipitate immune-related adverse events,3,4 40% of which lead to treatment cessation.5 Since their release, ICIs have been associated with serious immune-related cardiovascular adverse events,6 most prominently myocarditis,7 in case studies and case series.8,9 The simultaneous use of 2 different ICIs has been linked to a greater risk of such complications.10 Still, risk estimates have varied due to the relative rarity of this complication.11 The incidence of early and late cardiovascular toxicity with ICIs (alone and in combination) remains poorly described.5 |\n\nCorrespondence to: Sebastian Schneeweiss, MD, ScD, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 1 Brigham Circle, Boston, MA 02120. Email: [sschneeweiss@bwh.harvard.edu](sschneeweiss@bwh.harvard.edu)[ ](sschneeweiss@bwh.harvard.edu)[This manuscript was sent to Tochukwu M. Okwuosa](This manuscript was sent to Tochukwu M. Okwuosa) , DO, Associate Editor, for review by expert referees, editorial decision, and final disposition.  \nSupplemental Material is available at [https://www.ahajournals.org/doi/suppl/10.1161/JAHA.124.035689](https://www.ahajournals.org/doi/suppl/10.1161/JAHA.124.035689)[ ](https://www.ahajournals.org/doi/suppl/10.1161/JAHA.124.","cbCaiecpdJPJFHGW","https://ap.wps.com/l/cbCaiecpdJPJFHGW","pdf",1300471,"English","# Background\n# Methods and Results\n## Incidence and comparative risks\n# Conclusions\n# Clinical Perspective","[{\"question\":\"What was the study objective regarding immune checkpoint inhibitor therapy?\",\"answer\":\"To investigate the incidence of myocarditis in relation to using dual concurrent immune checkpoint inhibitors versus single immune checkpoint inhibitors.\"},{\"question\":\"How did the myocarditis risk compare between combination and monotherapy?\",\"answer\":\"Myocarditis occurred more often with combination therapy (0.7%) than with monotherapy (0.2%), with a higher risk ratio reported (3.12) and an adjusted hazard ratio of 2.38.\"},{\"question\":\"Did the study find a difference in heart failure risk?\",\"answer\":\"No difference in the risk of heart failure was found between combination and single therapy.\"}]","Myocarditis in Patients Starting Combination Checkpoint Inhibitor Therapy - Immune-related cardiovascular risk in real-world evidence | PDF",1790053411]