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High\u2010dose corticosteroids remain the first\u2010line therapy, yet their timing, dosage and tapering require careful clinical judgement. Early initiation substantially improves outcomes, but steroid resistance or delayed response is common and necessitates escalation to second\u2010 and third\u2010line immunosuppression or rescue therapies. The heterogeneity of available rescue therapies, including mycophenolate mofetil, abatacept, JAK inhibitors, plasmapheresis and other targeted agents, creates significant uncertainty, because evidence is largely limited to case reports and small case series. Management of ICI\u2010induced myocarditis requires balancing immunosuppression with cancer control, particularly when considering rechallenge. Prognostic uncertainty and limited long\u2010term data necessitate multidisciplinary, risk\u2010adapted care, while robust prospective evidence and standardised algorithms remain urgently needed.<\/jats:p>\n                  <jats:p>This review summarises current management strategies for ICI\u2013induced myocarditis, encompassing early high\u2010intensity corticosteroid therapy, treatment of fulminant disease, and the use of second\u2010 and third\u2010line and rescue immunosuppressive agents. Key clinical challenges, including steroid resistance, preservation of antitumour efficacy, ICI rechallenge, and emerging biomarker\u2010driven and translational approaches, are also addressed to support individualised care.<\/jats:p>","DOI":"10.1111\/bph.70536","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T02:05:28Z","timestamp":1781661928000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Refining the treatment of immune checkpoint inhibitor\u2013associated myocarditis: Challenges, innovations and rechallenge considerations"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9032-2630","authenticated-orcid":false,"given":"Raluca I.","family":"Mincu","sequence":"first","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Department of Dermatology, West German Skin Tumor Center Essen University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra","family":"Vlachopoulou","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Haj\u2010Yehia","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Michel","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Livingstone","sequence":"additional","affiliation":[{"name":"Department of Dermatology, West German Skin Tumor Center Essen University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Schadendorf","sequence":"additional","affiliation":[{"name":"Department of Dermatology, West German Skin Tumor Center Essen University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alpaslan","family":"Tasdogan","sequence":"additional","affiliation":[{"name":"Department of Dermatology, West German Skin Tumor Center Essen University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Totzeck","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tienush","family":"Rassaf","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen University Hospital Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.5500\/wjt.v13.i6.299"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/bph.70229"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/diseases12050088"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000186390.10150.66"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-024-50806-y"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.10.038"},{"key":"e_1_2_13_8_1","first-page":"1","article-title":"Steroid\u2010refractory autoimmune myocarditis after pembrolizumab therapy: Failure of equine anti\u2010thymocyte globulin to prevent heart failure","volume":"2","author":"Baclig N. 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