Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Curr Rheumatol Rep. 2019 Feb 21;21(4):10. doi: 10.1007/s11926-019-0811-3.
We clarify clinical characteristics of patients with immune checkpoint inhibitor (ICI)-induced myositis.
In 13 of 15 cases with ICI-induced myositis, the type of malignancy was melanoma. Eight, 4, and 3 patients received anti-PD-1 alone, anti-CTLA4 alone, and a combination of those, respectively. The mean period to the onset of ICI-induced myositis from the initiation of ICI was 4 weeks. Myocarditis was a complication in five patients. Seven of the patients died. The causes of death were myocarditis in three patients, respiratory muscle paralysis in two patients, and cancer progression in two patients. In patients without myocarditis or respiratory muscle paralysis, the prognosis for myositis was favorable with normalization of the CK levels occurring upon the cessation of ICI and the administration of immunosuppressive agents. Myocarditis and respiratory muscle paralysis are the major causes of death as immune-related adverse events in patients with ICI-induced myositis.
我们阐明了免疫检查点抑制剂(ICI)诱导性肌炎患者的临床特征。
在 15 例 ICI 诱导性肌炎患者中,有 13 例为恶性黑色素瘤。8 例、4 例和 3 例患者分别单独接受抗 PD-1、抗 CTLA4 和两者联合治疗。ICI 诱导性肌炎从开始使用 ICI 到发病的平均时间为 4 周。5 例患者并发心肌炎。7 例患者死亡。死亡原因分别为 3 例患者的心肌炎、2 例患者的呼吸肌瘫痪和 2 例患者的癌症进展。在没有心肌炎或呼吸肌瘫痪的患者中,肌炎的预后良好,在停止 ICI 并使用免疫抑制剂后,CK 水平恢复正常。心肌炎和呼吸肌瘫痪是 ICI 诱导性肌炎患者免疫相关不良事件导致死亡的主要原因。