Successful Use of Ruxolitinib for Steroid-Refractory Immune Checkpoint Inhibitor-Associated Myocarditis.

Q4 Medicine

JACC. Case reports Pub Date : 2025-09-30 DOI:10.1016/j.jaccas.2025.105543

Thomas Vockenhuber, Lukas Baldinger, Johannes Clausen, Georgios Kollias, Martin Schmid, Stefanie Schneiderbauer-Porod, Margarethe Strießnig, Martin Martinek, Christian Ebner

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Abstract

Background: Immune checkpoint inhibitors (ICIs) can trigger life-threatening immune-related adverse events, including myocarditis. Steroid-refractory cases pose significant therapeutic challenges.

Case summary: A 57-year-old woman with metastatic non-small cell lung cancer developed fulminant myocarditis with bidirectional ventricular tachycardia and biventricular dysfunction after pembrolizumab therapy. Despite early high-dose corticosteroids, cardiac biomarkers remained elevated and arrhythmias persisted. Second-line agents (mycophenolate mofetil, intravenous immunoglobulin) were discontinued owing to adverse effects. Off-label ruxolitinib was initiated after interdisciplinary discussion. This led to sustained clinical improvement, return to sinus rhythm, and recovery of biventricular function.

Discussion: This case highlights the therapeutic challenges in steroid-refractory ICI-associated myocarditis. Ruxolitinib may offer a promising option in these settings, though prospective data are lacking.

Take-home messages: ICI-associated myocarditis can present with ventricular arrhythmia and heart failure. Ruxolitinib may be considered in steroid-refractory cases.

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Ruxolitinib成功用于类固醇难治性免疫检查点抑制剂相关心肌炎。

背景：免疫检查点抑制剂（ICIs）可引发危及生命的免疫相关不良事件，包括心肌炎。类固醇难治性病例对治疗提出了重大挑战。病例总结：一名57岁的女性转移性非小细胞肺癌患者在接受派姆单抗治疗后发展为暴发性心肌炎并双向室性心动过速和双室功能障碍。尽管早期高剂量皮质类固醇，心脏生物标志物仍然升高，心律失常持续存在。二线药物（霉酚酸酯、静脉注射免疫球蛋白）由于不良反应而停用。ruxolitinib是在跨学科讨论后启动的。这导致持续的临床改善，窦性心律恢复，双心室功能恢复。讨论：本病例强调了类固醇难治性ici相关心肌炎的治疗挑战。Ruxolitinib可能在这些情况下提供一个有希望的选择，尽管缺乏前瞻性数据。关键信息：ici相关心肌炎可表现为室性心律失常和心力衰竭。Ruxolitinib可用于类固醇难治性病例。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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