Medication care of immune myocarditis induced by camrelizumab
10.3760/cma.j.cn114015-20220708-00615
- VernacularTitle:卡瑞利珠单抗致免疫性心肌炎的用药监护
- Author:
Yingqi LIANG
1
;
Siying CHEN
;
Pengcheng HOU
;
Ting YANG
;
Jun YANG
Author Information
1. 西安交通大学第一附属医院药学部，西安 710061
- Publication Type:Journal Article
- Keywords:
Myocarditis;
Immune checkpoint inhibitors;
Camrelizumab;
Immune-related adverse events;
Medication care
- From:
Adverse Drug Reactions Journal
2023;25(10):629-632
- CountryChina
- Language:Chinese
-
Abstract:
A 77-year-old male patient with lung cancer developed creatine kinase (CK) 887 U/L, CK-MB 89 μg/L, and high-sensitivity troponin I (hs-TnI) 43 750.1 ng/L, and ECG showed multilead ST-segment elevation after 2 cycles of combination chemotherapy with camrelizumab. The patient did not undergo the 3rd cycle of anti-tumor treatment. Clinical pharmacists participated in consultations and assisted physicians in analyzing the patient's medication. The causality between camrelizumab and the adverse event was considered as "possible" and the patient was diagnosed as immune myocarditis grade G3, receiving intravenous injection of 1 000 mg methylprednisolone pulse therapy once daily. Clinical pharmacists assisted physicians in reviewing data and developing glucocorticoid reduction plans. The dosage was reduced to 500 mg once daily after 2 days of pulse therapy. The patient's myocardial enzymes continued to decrease after glucocorticoid reduction. After 3 days, the dosage of methylprednisolone was reduced to 40 mg by intravenous injection once every 12 hours for 7 days. The patient's hs-TnI decreased to 2 248.6 ng/L. Methylprednisolone was changed to prednisone 40 mg twice daily orally. The physician's advice for prednisone dose reduction: reduce the dosage by 10-20 mg per week, monitor myocardial enzymes every week, and when the dosage is reduced to 10 mg/d, and if the myocardial enzymes return to normal, maintain it for 1-2 weeks before discontinuation. The patient followed the doctor's advice and successfully stopped medication, and no glucocorticoid-related adverse reactions and cardiac discomfort recurred. The patient did not receive immunotherapy again.
