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Association between immune checkpoint inhibitor-induced myocarditis and concomitant use of thiazide diuretics |
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| Authors: | Satoru Mitsuboshi Hirofumi Hamano Takahiro Niimura Aya F Ozaki Pranav M Patel Tsung-Jen Lin Yuta Tanaka Ikuya Kimura Naohiro Iwata Shoya Shiromizu Masayuki Chuma Toshihiro Koyama Yoshihiro Yamanishi Yasunari Kanda Keisuke Ishizawa Yoshito Zamami |
| Institution: | 1. Department of Pharmacy, Kaetsu Hospital, Niigata, Japan;2. Department of Pharmacy, Okayama University Hospital, Okayama, Japan;3. Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan;4. Department of Clinical Pharmacy Practice, University of California, Irvine, California, USA;5. Department of Cardiology, School of Medicine, University of California, Irvine, California, USA;6. Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan;7. Department of Hospital Pharmacy and Pharmacology, Asahikawa Medical University, Asahikawa, Japan;8. Department of Pharmaceutical Biomedicine, Okayama University, Okayama, Japan;9. Department of Complex Systems Science, Graduate School of Informatics Nagoya University, Nagoya, Japan;10. Division of Pharmacology, National Institute of Health Sciences, Kawasaki, Japan;11. Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan
Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan |
| Abstract: | Although an association has been reported between diuretics and myocarditis, it is unclear whether the risk of immune checkpoint inhibitor (ICI)-induced myocarditis is affected by concomitant diuretics. Thus, the aim of this work was to evaluate the impact of concomitant diuretics on ICI-induced myocarditis. This cross-sectional study used disproportionality analysis and a pharmacovigilance database to assess the risk of myocarditis with various diuretics in patients receiving ICIs via the analysis of data entered into the VigiBase database through December 2022. Multiple logistic regression analysis was performed to identify risk factors for myocarditis in patients who received ICIs. A total of 90 611 patients who received ICIs, including 975 cases of myocarditis, were included as the eligible dataset. A disproportionality in myocarditis was observed for loop diuretic use (reporting odds ratio 1.47, 95% confidence interval CI] 1.02-2.04, P = .03) and thiazide use (reporting odds ratio 1.76, 95% CI 1.20-2.50, P < .01) in patients who received ICIs. The results of the multiple logistic regression analysis showed that the use of thiazides (odds ratio 1.67, 95% CI 1.15-2.34, P < .01) was associated with an increased risk of myocarditis in patients who received ICIs. Our findings may help to predict the risk of myocarditis in patients receiving ICIs. |
| Keywords: | disproportionality analysis immune checkpoint inhibitor myocarditis thiazide diuretics |