From the Guidelines
The role of SGLT2 inhibitors in acute immunotherapy-induced myocarditis is currently investigational and not established as standard of care. While SGLT2 inhibitors (such as empagliflozin, dapagliflozin, and canagliflozin) have demonstrated cardioprotective effects in heart failure and may have anti-inflammatory properties that could theoretically benefit patients with myocarditis, there is insufficient clinical evidence to recommend their routine use specifically for immunotherapy-induced myocarditis 1.
Key Considerations
- Management of immunotherapy-induced myocarditis primarily involves immunosuppression with high-dose corticosteroids (typically methylprednisolone 1g/day or prednisone 1-2 mg/kg/day), potentially escalating to additional immunosuppressants like mycophenolate mofetil, infliximab, or anti-thymocyte globulin in severe or refractory cases 1.
- The theoretical benefit of SGLT2 inhibitors stems from their ability to reduce cardiac inflammation, improve energetics, and reduce cardiac workload through mechanisms including sodium-hydrogen exchanger inhibition and improved mitochondrial function.
- However, until clinical trials specifically evaluate SGLT2 inhibitors in this context, standard heart failure therapy and immunosuppression remain the cornerstone of treatment for immunotherapy-induced myocarditis.
Current Recommendations
- SGLT2 inhibitors are recommended for people with type 2 diabetes and increased cardiovascular risk or established cardiovascular disease to prevent the development of incident heart failure 1.
- In the context of immunotherapy-induced myocarditis, the focus should be on managing the condition with immunosuppression and standard heart failure therapy, rather than relying on SGLT2 inhibitors as a primary treatment strategy 1.
Future Directions
- Further research is needed to determine the potential benefits and risks of using SGLT2 inhibitors in patients with immunotherapy-induced myocarditis.
- Clinical trials should be conducted to evaluate the efficacy and safety of SGLT2 inhibitors in this specific context, and to inform evidence-based treatment guidelines 1.
From the Research
Role of SGLT2 Inhibitors in Acute Immunotherapy-Induced Myocarditis
- There is no direct evidence in the provided studies to suggest a role of SGLT2 inhibitors in acute immunotherapy-induced myocarditis.
- The studies focus on the treatment and management of immune checkpoint inhibitor-induced myocarditis, including the use of immunosuppressive therapy 2, 3, 4, advanced mechanical circulatory support 5, and conventional treatment strategies 6.
- None of the studies mention the use of SGLT2 inhibitors in the treatment of acute immunotherapy-induced myocarditis.
- The current treatment strategies for myocarditis are mostly supportive, with immunosuppression and immunomodulation therapies reserved for patients presenting with major clinical syndromes 6.
- Further research is needed to investigate the potential role of SGLT2 inhibitors in the treatment of acute immunotherapy-induced myocarditis, as the current evidence does not provide any insights into this topic 2, 3, 6, 4, 5.