Clinical spectrum of neuromuscular complications after immune checkpoint inhibition

Puwanant, Araya; Isfort, Michael; Lacomis, David; Živković, Saša

doi:10.1016/j.nmd.2018.11.012

Cited by 43 publications

(36 citation statements)

References 69 publications

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“…Myasthenia gravis was also excluded by the clinical pattern, the EMG and the negative serologic acetylcholine receptors antibodies. The incidence of serious neurologic irAEs is very low with anti-PDL-1/PD-1 (<1%), particularly for acute demyelinating polyneuropathy with an estimated frequency of 0.1%–0.2% 11–13. Although neurologic irAEs appear usually rapidly after treatment onset, our patient developed a polyradiculopathy very late in the treatment course, up to 1 year after nivolumab onset.…”

Section: Discussionmentioning

confidence: 64%

Isolated adrenocorticotropic hormone (ACTH) deficiency and Guillain-Barré syndrome occurring in a patient treated with nivolumab

et al. 2019

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The increased use of immune checkpoint inhibitors (ICIs) has led to the observation of a variety of immune-related adverse events (irAEs). These irAEs occur usually within the first months after ICIs onset and can involve theorically all organs. We describe two rare irAEs occurring in a 70-year-old caucasian man who was treated with nivolumab for an advanced urothelial cancer of the left kidney. He developed an isolated adrenocorticotropic hormone deficiency that was diagnosed at week 19 and a neurological complication that appeared at week 79 and initially confounded with a lumbar spinal stenosis. Diagnosis of Guillain-Barré syndrome was finally confirmed with the complete resolution of symptoms after 5 days of intravenous immunoglobulin and corticosteroids. We highlight the importance of quickly recognising these potential life-threatening irAEs such as cortisol insufficiency and neurologic adverse events whose initially presentation could be non-specific.

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Section: Discussionmentioning

confidence: 64%

Isolated adrenocorticotropic hormone (ACTH) deficiency and Guillain-Barré syndrome occurring in a patient treated with nivolumab

et al. 2019

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“…Since the introduction of immune checkpoint inhibitors (ICI) in cancer immunotherapy, several cases of myasthenia gravis and immune‐mediated myopathies in ICI‐treated patients have been reported . ICI‐induced neuromuscular complications have emerged as rare but serious adverse effects of these medications and generally develop within 3 months of initiating therapy . Only a minority of patients have pre‐existing myasthenia gravis or myositis .…”

Section: Acquired Neuromuscular Junction Disorders With Coexisting Mymentioning

confidence: 99%

“…Most cases of ICI‐associated myasthenia gravis are generalized and seropositive for AChR antibodies. More than half of these patients also have elevated CK levels, suggesting a coexisting myopathy or myocarditis . Other patients present with a primarily myopathic phenotype.…”

Section: Acquired Neuromuscular Junction Disorders With Coexisting Mymentioning

confidence: 99%

“…These features alone therefore do not reliably indicate the presence of myasthenia in ICI‐treated patients . While ICI‐induced neuromuscular complications may respond to discontinuation of the precipitating agent and immunomodulatory treatment, they are associated with high rates of morbidity and mortality as a result of cancer recurrence, myocarditis or the neuromuscular disorders themselves, particularly respiratory compromise due to myasthenia gravis or myopathy …”

Section: Acquired Neuromuscular Junction Disorders With Coexisting Mymentioning

confidence: 99%

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Trouble at the junction: When myopathy and myasthenia overlap

2019

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Although myopathies and neuromuscular junction disorders are typically distinct, their coexistence has been reported in several inherited and acquired conditions. Affected individuals have variable clinical phenotypes but typically display both a decrement on repetitive nerve stimulation and myopathic findings on muscle biopsy. Inherited causes include myopathies related to mutations in BIN1, DES, DNM2, GMPPB, MTM1, or PLEC and congenital myasthenic syndromes due to mutations in ALG2, ALG14, COL13A1, DOK7, DPAGT1, or GFPT1. Additionally, a decrement due to muscle fiber inexcitability is observed in certain myotonic disorders. The identification of a defect of neuromuscular transmission in an inherited myopathy may assist in establishing a molecular diagnosis and in selecting patients who would benefit from pharmacological correction of this defect. Acquired cases meanwhile stem from the co‐occurrence of myasthenia gravis or Lambert‐Eaton myasthenic syndrome with an immune‐mediated myopathy, which may be due to paraneoplastic disorders or exposure to immune checkpoint inhibitors.

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“…Muscle involvement in MG has been barely reported [3][4][5][6], sometimes related to other autoimmune disorders [4] or immunotherapy [6]. To our knowledge, only one case with acute onset has been described [5].…”

mentioning

confidence: 95%

Acute concomitant presentation of polymyositis and atypical myasthenia gravis: a diagnostic challenge

Natera‐Villalba

Corral‐Corral

Cabañes

et al. 2020

Euro J of Neurology

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Clinical spectrum of neuromuscular complications after immune checkpoint inhibition

Cited by 43 publications

References 69 publications

Isolated adrenocorticotropic hormone (ACTH) deficiency and Guillain-Barré syndrome occurring in a patient treated with nivolumab

Isolated adrenocorticotropic hormone (ACTH) deficiency and Guillain-Barré syndrome occurring in a patient treated with nivolumab

Trouble at the junction: When myopathy and myasthenia overlap

Acute concomitant presentation of polymyositis and atypical myasthenia gravis: a diagnostic challenge

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