CTLA-4 agonist abatacept, alemtuzumab, tocilizumab, rituximab, anti-thymocyte globulin, intravenous immunoglobulins, tacrolimus, mycophenolate, azathioprine, methotrexate, cyclophosphamide, and infliximab or plasmapheresis have been used in steroid-refractory cases of myocarditis, although infliximab is not preferred at higher dosing given its association with cardiac failure [34,64,79]. Here, CTLA4 is linked to heart failure.