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Myasthenia triggered by immune checkpoint inhibitors: New case and literature review.

Publication ,  Journal Article
Gonzalez, NL; Puwanant, A; Lu, A; Marks, SM; Živković, SA
Published in: Neuromuscul Disord
March 2017

Immune checkpoint molecules are potent regulators of immunologic homeostasis that prevent the development of autoimmunity while maintaining self-tolerance. Inhibitors of immune checkpoint molecules are used as immunotherapy in the treatment of melanoma and different types of refractory cancer, and can trigger various autoimmune complications including myositis and myasthenia gravis. We describe a case of generalized myasthenia gravis induced by pembrolizumab and review 11 other cases. Five patients also had elevated serum CK levels ranging from 1200 to 8729 IU/L, and biopsy showed myositis in one. Severity was highly variable as symptoms normalized spontaneously in one patient, but three others developed myasthenic crisis (including two with fatal outcomes). Steroids have been recommended as a preferred treatment of autoimmune complications of immune-checkpoint inhibitors. Myasthenia gravis should be considered when weakness, diplopia or bulbar symptoms are seen after treatment with immune checkpoint inhibitors, and additional studies are needed to characterize association with hyperCKemia.

Duke Scholars

Published In

Neuromuscul Disord

DOI

EISSN

1873-2364

Publication Date

March 2017

Volume

27

Issue

3

Start / End Page

266 / 268

Location

England

Related Subject Headings

  • Neurology & Neurosurgery
  • Myasthenia Gravis
  • Humans
  • Female
  • Creatine Kinase
  • Antineoplastic Agents, Immunological
  • Antibodies, Monoclonal, Humanized
  • Aged
  • 5202 Biological psychology
  • 3209 Neurosciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Gonzalez, N. L., Puwanant, A., Lu, A., Marks, S. M., & Živković, S. A. (2017). Myasthenia triggered by immune checkpoint inhibitors: New case and literature review. Neuromuscul Disord, 27(3), 266–268. https://doi.org/10.1016/j.nmd.2017.01.002
Gonzalez, Natalia L., Araya Puwanant, Angela Lu, Stanley M. Marks, and Saša A. Živković. “Myasthenia triggered by immune checkpoint inhibitors: New case and literature review.Neuromuscul Disord 27, no. 3 (March 2017): 266–68. https://doi.org/10.1016/j.nmd.2017.01.002.
Gonzalez NL, Puwanant A, Lu A, Marks SM, Živković SA. Myasthenia triggered by immune checkpoint inhibitors: New case and literature review. Neuromuscul Disord. 2017 Mar;27(3):266–8.
Gonzalez, Natalia L., et al. “Myasthenia triggered by immune checkpoint inhibitors: New case and literature review.Neuromuscul Disord, vol. 27, no. 3, Mar. 2017, pp. 266–68. Pubmed, doi:10.1016/j.nmd.2017.01.002.
Gonzalez NL, Puwanant A, Lu A, Marks SM, Živković SA. Myasthenia triggered by immune checkpoint inhibitors: New case and literature review. Neuromuscul Disord. 2017 Mar;27(3):266–268.
Journal cover image

Published In

Neuromuscul Disord

DOI

EISSN

1873-2364

Publication Date

March 2017

Volume

27

Issue

3

Start / End Page

266 / 268

Location

England

Related Subject Headings

  • Neurology & Neurosurgery
  • Myasthenia Gravis
  • Humans
  • Female
  • Creatine Kinase
  • Antineoplastic Agents, Immunological
  • Antibodies, Monoclonal, Humanized
  • Aged
  • 5202 Biological psychology
  • 3209 Neurosciences