Myasthenia gravis: An emerging toxicity of immune checkpoint inhibitors

2017 ◽  
Vol 82 ◽  
pp. 128-136 ◽  
Author(s):  
D. Makarious ◽  
K. Horwood ◽  
J.I.G. Coward
Keyword(s):  
Myasthenia Gravis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors

Myasthenia gravis induced or exacerbated by immune checkpoint inhibitors: a rising concern

2021 ◽  
Vol 14 (8) ◽  
pp. e243764 ◽  
Author(s):  
Behnam Hajihossainlou ◽  
Alisa Vasileva ◽  
Sukesh Manthri ◽  
Kanishka Chakraborty
Keyword(s):  
Respiratory Failure ◽  
Myasthenia Gravis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Single Agent ◽  
Therapy Options ◽  
Severity Of The Disease ◽  
Cell Death Protein ◽  
New Onset

Immune checkpoint inhibitors can cause immune side effects, with myasthenia gravis (MG) being relatively rare. With this review, we present 66-year-old man with melanoma treated with pembrolizumab who developed MG. With immuno-oncology (IO) single agent usage, 42 cases reported new-onset MG and 9 cases reported exacerbation of pre-existing MG. Among the patients who had new-onset MG after administration of programmed cell death protein 1 (PD-1) inhibitors, 14 patients (38.8%) developed severe respiratory failure and required intubation and 10 patients (27.02%) died. Among the patients with exacerbation of pre-existing MG after receiving PD-1 inhibitors, 1 patient (11.1%) required intubation, and no death was reported. Combination IO therapy-induced MG was reported in seven cases, with at least two cases complicated by respiratory failure and one death. Our observations suggest a possible difference in the severity of the disease and outcome among different IO therapy options.

scholarly journals Use of immune checkpoint inhibitors (CPI) in patients with cancer and concomitant myasthenia gravis (MG)

2018 ◽  
Vol 29 ◽  
pp. viii427
Author(s):  
H. Safa ◽  
N. Abdel-Wahab ◽  
V.A. Trinh ◽  
D.H. Johnson ◽  
T.E. Rodgers ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Patients With Cancer

scholarly journals Unusual Adverse Effects of Immune Checkpoint Inhibitors: Autonomic Neuropathy, Palmoplantar Keratoderma, Reiter Syndrome & Myasthenia Gravis: A Case Series and Review of the Literature

2020 ◽  
Vol 5 (11) ◽  
pp. 554-560
Author(s):  
Walid Shalata ◽  
Alexander Yakobson ◽  
Ismaell Massalha ◽  
Aharon Y. Cohen ◽  
Iris M. Goldstein ◽  
...  
Keyword(s):  
Adverse Events ◽  
Myasthenia Gravis ◽  
Lung Adenocarcinoma ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Case Series ◽  
Palmoplantar Keratoderma ◽  
Stage 4 ◽  
Reiter Syndrome

The immune checkpoint inhibitors (ICIs) have transformed the standards of care in cancer treatment and has dramatically improved patient prognoses. As a result of the introduction of these novel treatments several types of adverse events related to ICIs (immune related adverse events ((irAEs)) have been observed and reported. In this case series we describe the clinical course of four patients, with unusual ICI induced toxicities. The first patient was a 59 year-old female who received chemo-immunotherapy (pembrolizumab) for stage 4- lung adenocarcinoma, and developed autonomic neuropathy (AN). The second and third patients were both 63 year-old males who also received chemo-immunotherapy (pembrolizumab) for stage 4-A lung adenocarcinoma. One of those patients developed palmoplantar keratoderma and one developed conjunctivitis, urethritis and arthritis (Reiter syndrome). The fourth patient was an 80 year-old male who received chemo-immunotherapy (pembrolizumab) for stage 3-A squamous cell carcinoma of the lung and developed myasthenia gravis.

Nivolumab-related myasthenia gravis with myositis and myocarditis in Japan

Neurology ◽  
2017 ◽  
Vol 89 (11) ◽  
pp. 1127-1134 ◽  
Author(s):  
Shigeaki Suzuki ◽  
Nobuhisa Ishikawa ◽  
Fumie Konoeda ◽  
Nobuhiko Seki ◽  
Satoshi Fukushima ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Control Group ◽  
Myasthenic Crisis ◽  
Daily Living Activity ◽  
Patients With Cancer ◽  
Bulbar Symptoms ◽  
Receptor Antibodies

Objective:To report the clinical features of myasthenia gravis (MG) induced by treatment with immune checkpoint inhibitors using 2-year safety databases based on postmarketing surveys in Japan.Methods:We studied 10,277 patients with cancer who had received monotherapy with either nivolumab or ipilimumab between September 2014 and August 2016. As the control group, 105 patients with idiopathic MG were used.Results:There were 12 MG cases (0.12%) among 9,869 patients with cancer who had been treated with nivolumab, but none among 408 patients treated with ipilimumab. These 12 patients included 6 men and 6 women with a mean age of 73.5 ± 6.3 years. MG onset occurred in the early phase after nivolumab treatment and rapidly deteriorated. Nivolumab-related MG (nivoMG) included 4 patients with mild involvement and 8 patients with severe involvement. Bulbar symptoms and myasthenic crisis were observed more frequently in nivoMG than idiopathic MG. Ten patients were positive for anti–acetylcholine receptor antibodies. Serum creatine kinase levels were markedly elevated to an average level of 4,799 IU/L. Among the 12 patients with nivoMG, 4 had myositis and 3 had myocarditis, with 1 of these patients having both. Immunosuppressive therapy was effective. Postintervention status showed that pharmacologic remission or minimal manifestations were obtained in 4 patients; however, 2 patients died. Immune-related adverse events triggered by nivolumab impaired the patients' daily living activity.Conclusions:The prompt and correct recognition of MG following treatment with immune checkpoint inhibitors in patients with cancer is important.

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