Immune Checkpoint Inhibitor-induced Myositis

Athira Jayan; Andrew L Mammen; Maria E Suarez-Almazor

doi:10.1016/j.rdc.2024.02.003

Immune Checkpoint Inhibitor-induced Myositis

Rheum Dis Clin North Am. 2024 May;50(2):281-290. doi: 10.1016/j.rdc.2024.02.003. Epub 2024 Mar 12.

Authors

Athira Jayan¹, Andrew L Mammen², Maria E Suarez-Almazor³

Affiliations

¹ Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
² Department of Neurology, Johns Hopkins University School of Medicine; Department of Medicine, Johns Hopkins University School of Medicine; Muscle Disease Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 50, Room 1146, Bethesda, MD 20892, USA.
³ Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, 1515 Holcombe Boulevard, Houston, TX 77030, USA; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA; Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: msalmazor@mdanderson.org.

PMID: 38670726
DOI: 10.1016/j.rdc.2024.02.003

Abstract

Myositis induced by immune checkpoint inhibitors (ICIs) is an infrequent, potentially fatal, immune-related adverse event. It has higher incidence in patients who receive combination ICI therapy compared to monotherapy. Patients can present with clinical manifestation symptoms of myositis alone or in combination with myocarditis and/or myasthenia gravis, which significantly worsens the course and prognosis. Diagnosis can generally be made on the basis of clinical presentation, elevation of muscle enzymes, and electromyographic changes, but some patients may require a muscle biopsy. The first line of therapy is high-dose corticosteroids, followed by immunosuppression, plasmapheresis, or intravenous immunoglobulin in patients with severe disease.

Keywords: Immune checkpoint inhibitors; Immune-related adverse events; Myasthenia gravis; Myocarditis; Myositis.

Publication types

Review

MeSH terms

Humans
Immune Checkpoint Inhibitors* / adverse effects
Immunoglobulins, Intravenous / therapeutic use
Myositis* / chemically induced
Myositis* / diagnosis
Myositis* / immunology
Myositis* / therapy

Substances

Immune Checkpoint Inhibitors
Immunoglobulins, Intravenous