Abstract
Myocarditis and pericarditis are managed with various treatments, yet prior studies and case reports indicate that certain drug classes may elevate the risk for these inflammatory cardiac conditions. This research aimed to systematically identify the leading drugs most frequently associated with myocarditis and pericarditis cases. Analyses were carried out using the global database of individual case safety reports from 1968 to 2024. We identified the drugs most frequently reported in signal detection with myocarditis and pericarditis, selecting the top 10 drugs based on record count, excluding those used in the treatment of inflammatory cardiac conditions to avoid potential confounding. Two statistical indicators, the information component (IC) with IC(025) and reporting odds ratio (ROR) with 95% confidence interval (CI) were used to conduct the disproportionality analysis in this study. The following five drugs were consistently observed with both myocarditis and pericarditis: clozapine, mesalazine, smallpox vaccine, influenza vaccine, and COVID-19 mRNA vaccine. The other leading drugs differed by condition, with nivolumab, pembrolizumab, ipilimumab, valproate, and metronidazole appearing more frequently for myocarditis, and ribavirin, sulfasalazine, methotrexate, omalizumab, and heparin for pericarditis. Each of these drugs showed a significant signal detection with myocarditis (ROR, 83.22 [95% CI, 81.17-85.33]; IC, 3.96 [IC(025), 3.94]) and pericarditis (42.16 [41.19-43.16]; 3.66 [3.64]). Although our findings did not allow for causal inference, these findings highlight the importance of monitoring for possible adverse carditis cases when prescribing these drugs. Further studies are encouraged to investigate underlying mechanisms, assess individual patient risk factors, and explore the long-term impacts associated with myocarditis and pericarditis in relation to drug.