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Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis · Journal article
Discover Medicine · September 11, 2026
A consensus or society position rather than new primary data.
This narrative review synthesizes current epidemiology, diagnostic criteria, and management evidence for ICI-associated myocarditis, a rare but life-threatening complication with mortality of approximately 26% in recent cohorts. First-line therapy is high-dose intravenous methylprednisolone, with second-line agents (mycophenolate mofetil, tacrolimus, abatacept, anti-thymocyte globulin, infliximab, tocilizumab, ruxolitinib) supported only by case series and small cohorts. The review recommends a structured multidisciplinary approach integrating early recognition, systematic risk stratification, and prompt immunosuppression, while acknowledging that evidence for second-line therapy remains limited.
Narrative review. Literature on epidemiology, pathophysiology, diagnosis, and management of immune checkpoint inhibitor-associated myocarditis; framed by IC-OS 2021 and ACC 2024 consensus criteria..
Mortality ranges from 27 to 50% in earlier cohorts, with recent pooled estimate approximately 26% Incidence approximately 1%, rising to 2–4% with combination immune checkpoint inhibitor regimens Up to half of severe cases fail first-line therapy and require escalation to second-line agents
Mortality ranges from 27 to 50% in earlier cohorts, with recent pooled estimate approximately 26%
Clinicians should adopt the structured multidisciplinary diagnostic approach outlined by IC-OS 2021 and ACC 2024 consensus, beginning with high-dose intravenous methylprednisolone as first-line therapy. Recognition that second-line evidence is observational and limited should inform shared decision-making and expert consultation when first-line therapy fails.
A narrative review synthesizing observational evidence and consensus diagnostic/management criteria from cardio-oncology societies to inform structured multidisciplinary care of a rare life-threatening adverse event.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should adopt the structured multidisciplinary diagnostic approach outlined by IC-OS 2021 and ACC 2024 consensus, beginning with high-dose intravenous methylprednisolone as first-line therapy. Recognition that second-line evidence is observational and limited should inform shared decision-making and expert consultation when first-line therapy fails.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Immune checkpoint inhibitor-associated myocarditis (ICI-M) is a rare but life-threatening immune-related adverse event. Reported mortality ranges from 27 to 50% in earlier cohorts, with a more recent pooled estimate of approximately 26% in systematic reviews incorporating 2021 to 2022 data. Incidence is approximately 1%, rising to 2 to 4% with combination regimens. We performed a narrative review of the epidemiology, pathophysiology, overlap syndromes, risk stratification, diagnostic criteria, and immunosuppressive management of ICI-M. Diagnosis integrates an obligate rise in high-sensitivity troponin with multimodal imaging, framed by the International Cardio-Oncology Society (IC-OS) 2021 criteria and the 2024 American College of Cardiology (ACC) Consensus Pathway, after exclusion of acute coronary syndrome and infectious myocarditis. Risk stratification is discussed using a recently reported multivariable risk score. High-dose intravenous methylprednisolone is the accepted first-line therapy, with observational data associating higher initial dosing with more favourable biomarkers and survival trends. Up to half of severe cases fail first-line therapy and require escalation. Evidence for second-line agents, including mycophenolate mofetil, tacrolimus, abatacept, anti-thymocyte globulin, infliximab, tocilizumab, and ruxolitinib, derives from case series and small cohorts rather than randomised trials, and is presented with that limitation stated. ICI-M requires a structured, multidisciplinary approach integrating early recognition, systematic risk stratification, prompt high-dose immunosuppression, and a structured escalation approach for steroid-refractory disease, recognising that second-line evidence remains limited. This review synthesises the current, largely observational evidence to support individualised multidisciplinary management, and distinguishes guideline-endorsed recommendations from areas resting on limited or emerging data.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.