Do immune checkpoint inhibitors share the same pharmacological feature in the risk of cardiac arrhythmias? - 17/06/23
, Liberata Sportiello a, b, Concetta Rafaniello a, b, Maria Donniacuo b, Donatella Ruggiero a, b, Lucia Scisciola c, Michelangela Barbieri c, Francesco Rossi a, b, Giuseppe Paolisso c, 1, Annalisa Capuano a, b, 1Abstract |
Background |
Despite the available evidence showing an association between cardiac arrhythmia and Immune Checkpoint Inhibitors (ICIs), few studies have compared this risk between ICIs.
Objectives |
We aim to evaluate Individual Case Safety Reports (ICSRs) of ICIs-induced cardiac arrhythmias and compare the reporting frequency of cardiac arrhythmias among ICIs.
Methods |
ICSRs were retrieved from the European Pharmacovigilance database (Eudravigilance). ICSRs were classified based on the ICI reported (pembrolizumab, nivolumab, atezolizumab, ipilimumab, durvalumab, avelumab, cemiplimab, and dostarlimab). If more than one ICI was reported, the ICSR was classified as a combination of ICIs. ICSRs of ICI-related arrhythmias were described and the reporting frequency of cardiac arrhythmias was assessed by applying the reporting odds ratio (ROR) and its 95 % confidence interval (95 %CI).
Results |
A total of 1262 ICSRs were retrieved, of which 147 (11.65 %) were related to combinations of ICIs. A total of 1426 events of cardiac arrhythmias were identified. The three most reported events were atrial fibrillation, tachycardia, and cardiac arrest. Ipilimumab was associated with a reduced reporting frequency of cardiac arrhythmias compared to all other ICIs (ROR 0.71, 95 %CI 0.55–0.92; p = 0.009). Anti-PD1 was associated with a higher reporting frequency of cardiac arrhythmias than anti-CTLA4 (ROR 1.47, 95 %CI 1.14–1.90; p = 0.003).
Conclusion |
This study is the first comparing ICIs for the risk of cardiac arrhythmias. We found that ipilimumab was the only ICI associated with a reduced reporting frequency. Further high-quality studies are needed to confirm our results.
Le texte complet de cet article est disponible en PDF.Graphical Abstract |
Highlights |
• | Most events of cardiac arrhythmias were severe and fatal. |
• | Ipilimumab had a lower reporting frequency of arrhythmia than all other ICIs. |
• | ICIs may share different pharmacological feature in terms of cardiac arrhythmias |
• | The CTLA4 pathway may be less critical in the heart. |
Keywords : Cardiac arrhythmia, Immune Checkpoint Inhibitors, European, Safety, Spontaneous reporting
Plan
Vol 164
Article 114912- août 2023 Retour au numéro
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