Refractory myasthenia gravis exacerbation triggered By pembrolizumab

Earl, Damien E.; Loochtan, Aaron I.; Bedlack, Richard

doi:10.1002/mus.26021

Cited by 21 publications

(9 citation statements)

References 16 publications

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“…We obtained data for 17 cases of ICI therapy followed by MG with hyperCKemia or anti‐striational antibody, as shown in Table . The patients in 15 cases had hyperCKemia and the patients in four of these cases complained of myalgia.…”

Section: Resultsmentioning

confidence: 99%

Immune checkpoint inhibitors in the onset of myasthenia gravis with hyperCKemia

Takamatsu

Nakane

Suzuki

et al. 2018

Ann Clin Transl Neurol

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Immune checkpoint inhibitors sometimes cause neuromuscular adverse events. Although a few cases of myasthenia gravis with hyperCKemia triggered by immune checkpoint inhibitors have been described, conclusive evidence remains limited. We conducted a systematic review of published cases of myasthenia gravis with hyperCKemia related to immune checkpoint inhibitors. Moreover, we tested anti‐striational antibodies in the case of myasthenia gravis with myositis after nivolumab administration. We located 17 published case reports. Anti‐striational antibodies were tested in six cases and five cases were positive. Our systematic analyses revealed poor prognosis in myasthenia gravis combined hyperCKemia with immune checkpoint inhibitors.

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Section: Resultsmentioning

confidence: 99%

Immune checkpoint inhibitors in the onset of myasthenia gravis with hyperCKemia

Takamatsu

Nakane

Suzuki

et al. 2018

Ann Clin Transl Neurol

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“…Of these, nine cases were new‐onset MG , and four cases were exacerbations of pre‐existing MG . Ten cases were of metastatic melanoma , and the remaining three cases were of thymic cancer , uterine carcinosarcoma , and lung squamous cell cancer (our case), respectively. Only five of these cases presented CPK elevation (reported as 10,386 IU/L, 4361 IU/L [our case], 2125 IU/L, 1200 IU/L, and “slightly elevated”).…”

Section: Discussionmentioning

confidence: 85%

Pembrolizumab‐induced myasthenia gravis with myositis in a patient with lung cancer

Hibino¹,

Maeda²,

Horiuchi³

et al. 2018

Respirology Case Reports

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In the new era of cancer immunotherapy, clinical research has uncovered diverse and unpredictable immune‐related adverse events. Here, we report the first case of pembrolizumab‐induced myasthenia gravis (MG) and myositis in a patient with lung cancer. The patient developed symptoms after the second infusion of pembrolizumab and was successfully treated with systemic corticosteroid therapy. With the accelerated development of immune checkpoint inhibitors as mono‐ or combination therapies for various malignancies, clinicians should closely monitor patients for important immune‐related adverse events, such as MG, especially during the early phase of the treatment.

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“…Here, nivolumab treatment was successful in a patient with pre‐existing MG, in contrast to case reports of ICI‐related myasthenic crises and death in MG patients even when in remission . ICI‐related autoimmunity may also include concurrent myositis and myocarditis mimicking or aggravating myasthenic weakness, possibly requiring ventilatory support .…”

mentioning

confidence: 68%