Relapsed Myasthenia Gravis after Nivolumab Treatment

Abstract

Nivolumab is a newly introduced promising therapy for treating lung cancer that restores the anti-tumor immunity by disrupting programmed cell death-1-mediated immuno-suppressive signaling. Although “new-onset” autoimmune diseases are well-known immune-related adverse events, whether or not nivolumab exacerbates “pre-existing” autoimmune disease remains unclear. We herein report a patient with “pre-existing” myasthenia gravis in whom nivolumab was administered that flared up after the treatment with nivolumab. Regardless of the disease stability, nivolumab has the potential to exacerbate an autoimmune disease, and we must pay close attention to each patient's medical history before administering this agent.

Immune checkpoint inhibitors in the onset of myasthenia gravis with hyperCKemia

“…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.…”

Immune checkpoint inhibitors‐induced neuromuscular toxicity: From pathogenesis to treatment

“…There is a single case report of a patient with relapsing ocular MG and positive anti‐AChR and anti‐muscle‐specific kinase (MuSK) antibodies following nivolumab treatment. She subsequently developed an overlap syndrome with both irMyositis and irMG . Among the fatal cases of irMG reported in the literature, most of them had associated myositis and/or myocarditis …”

Myasthenia gravis and myopathy after nivolumab treatment for non‐small cell lung carcinoma: A case report

“…In this case report, acute myopathy and myasthenia gravis was noted. The combination of these two conditions suggests very rare dysimmune toxicity, and several cases of myasthenia gravis with hyperCKemia have been reported worldwide . It is postulated that the simultaneous formation of AChR antibody and anti‐striational antibodies is required to develop myasthenia gravis with myositis.…”

“…They rarely cause fatal side effects, but recently, specific immune‐related adverse events (irAEs) involving neuromuscular systems have been reported . Several cases of myasthenia gravis with myopathy have already been published, but the exact mechanisms of these conditions are still unclear . Here, we report a case of myasthenia gravis and acute myopathy in a patient treated with nivolumab.…”