ArticlePloS one2022
Immune checkpoint inhibitor monotherapy is associated with less cardiac toxicity than combination therapy.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 22 citations in OpenAlex.
- Cardiotoxicity in cancer immunotherapy: a systematic review and global meta-analysis.Journal of translational medicine · 2025Pooled it
- Immune Checkpoint Inhibitors and Cardiotoxicity: A Comparative Meta-Analysis of Observational Studies and Randomized Controlled Trials.Journal of the American Heart Association · 2024Pooled it
- Immune checkpoint inhibitor-associated myocarditis: clinical and mechanistic insights.Inflammation research : official journal of the European Histamine Research Society ... [et al.] · 2026Review
- Pregnancy adverse events with immune checkpoint inhibitors in monotherapy and combination therapy in cancer: a disproportionality analysis.EClinicalMedicine · 2026Article
- Risk factors associated with cardiovascular hospital admissions and all-cause mortality in cancer patients treated with immune checkpoint inhibitors.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- Differential Diagnosis between Sintilimab-related Autoimmune Myocarditis and Acute Myocardial Infarction.Biological procedures online · 2026Review
- Caught in the crossfire: cardiac complications of cancer therapy.The Journal of clinical investigation · 2026Review
- Cardiovascular toxicity induced by immune checkpoint inhibitors: mechanisms linking immune dysregulation and myocardial fibrosis.American journal of clinical and experimental immunology · 2026Review
- Immune checkpoint inhibitor-associated arrhythmias: clinical challenges, artificial intelligence-enhanced monitoring, and management strategies.Frontiers in cardiovascular medicine · 2026Review
- From tumor immunotherapy to myocardial injury: A mechanistic discussion of immune checkpoint inhibitor‑related myocarditis (Review).Molecular medicine reports · 2025Review
- Immune checkpoint inhibitors and cardiovascular toxicity: immunology, pathophysiology, diagnosis, and management.Journal of thrombosis and thrombolysis · 2025Review
- Use of rituximab for fulminant and refractory cases of immune checkpoint inhibitor induced myocyte injury clinically presenting with features of myasthenia gravis: a case series.European heart journal. Case reports · 2025Article
- Post-marketing Safety Assessment of CAR T-cell Therapies: Analysis of Individual Case Safety Reports in the VigiBase.Therapeutic innovation & regulatory science · 2025Article
- Risk factors of immune checkpoint inhibitor-related cardiotoxicity: a scoping review.The oncologist · 2025Article
- Review
- Article
- Combinatorial immune checkpoint blockade increases myocardial expression of NLRP-3 and secretion of H-FABP, NT-Pro-BNP, interleukin-1β and interleukin-6: biochemical implications in cardio-immuno-oncology.Frontiers in cardiovascular medicine · 2024Article
- Article
Corrections and comments
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Authors and funding
11 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTreatment options for many cancers include immune checkpoint inhibitor (ICI) monotherapy and combination therapy with impressive clinical benefit across cancers. We sought to define the comparative cardiac risks of ICI combination and monotherapy.
methodsWe used VigiBase, the World Health Organization pharmacovigilance database, to identify cardiac ADRs (cADRs), such as carditis, heart failure, arrhythmia, myocardial infarction, and valvular dysfunction, related to ICI therapy. To explore possible relationships, we used the reporting odds ratio (ROR) as a proxy of relative risk. A lower bound of a 95% confidence interval of ROR > 1 reflects a disproportionality signal that more ADRs are observed than expected due to chance.
resultsWe found 2278 cADR for ICI monotherapy and 353 for ICI combination therapy. Combination therapy was associated with significantly higher odds of carditis (ROR 6.9, 95% CI: 5.6-8.3) versus ICI monotherapy (ROR 5.0, 95% CI: 4.6-5.4). Carditis in ICI combination therapy was fatal in 23.4% of reported ADRs, compared to 15.8% for ICI monotherapy (P = 0.058).
conclusionsUsing validated pharmacovigilance methodology, we found increased odds of carditis for all ICI therapies, with the highest odds for combination therapy. Given the substantial risk of severe ADR and death, clinicians should consider these findings when prescribing checkpoint inhibitors.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.