以抗PD-1抗体为代表药物，免疫检查点抑制剂(ICIs)已成为治疗许多晚期恶性肿瘤的主要药物。然而,免疫相关不良事件（IRAE），可能涉及多器官疾病，不应该被忽视。ICI诱发的心肌炎是一种罕见但危及生命的irAE。糖皮质激素是ICI诱发心肌炎患者的首选治疗方法,但高比例的类固醇难治性和类固醇耐药病例持续存在。根据目前的指导方针，肿瘤坏死因子α（TNF-α）抑制剂被推荐用于对类固醇治疗无反应并患有严重心脏毒性的患者。尽管缺乏循证研究。另一方面,TNF-α抑制剂在中度至重度心力衰竭患者中是禁忌的。这篇综述总结了TNF-α抑制剂和其他生物制剂治疗ICI诱发心肌炎的实际数据，为TNF-α抑制剂和其他生物制剂的有效性和安全性提供了更多证据。
With anti-PD-1 antibodies serving as a representative drug, immune checkpoint inhibitors (ICIs) have become the main drugs used to treat many advanced malignant tumors. However, immune-related adverse events (irAEs), which might involve multiple organ disorders, should not be ignored. ICI-induced myocarditis is an uncommon but life-threatening irAE. Glucocorticoids are the first choice of treatment for patients with ICI-induced myocarditis, but high proportions of steroid-refractory and steroid-resistant cases persist. According to present guidelines, tumor necrosis factor alpha (TNF-α) inhibitors are recommended for patients who fail to respond to steroid therapy and suffer from severe cardiac toxicity, although evidence-based studies are lacking. On the other hand, TNF-α inhibitors are contraindicated in patients with moderate-to-severe heart failure. This review summarizes real-world data from TNF-α inhibitors and other biologic agents for ICI-induced myocarditis to provide more evidence of the efficacy and safety of TNF-α inhibitors and other biologic agents.
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