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

Authors

Behnam Hajihossainlou, Advocate Aurora HealthFollow
Alisa Vasileva
Sukesh Manthri
Kanishka Chakraborty

Recommended Citation

Hajihossainlou B, Vasileva A, Manthri S, Chakraborty K. Myasthenia gravis induced or exacerbated by immune checkpoint inhibitors: a rising concern. BMJ Case Rep. 2021;14(8):e243764. doi: 10.1136/bcr-2021-243764

Affiliations

Aurora Medical Center Bay Area

Abstract

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.

Document Type

Article

PubMed ID

34426425