Wang Chunjiang, Zeng Hanqing, Fang Weijin, Song Liying
Department of Pharmacy, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, YueLu District, 410013, Changsha, Hunan, China.
Invest New Drugs. 2023 Apr;41(2):333-339. doi: 10.1007/s10637-023-01347-6. Epub 2023 Mar 29.
To investigate the clinical features of nivolumab-induced myasthenia gravis (MG) and provide evidence for the rational use of nivolumab in the clinic.
We collected case reports and case series of nivolumab-induced MG for retrospective analysis by searching Chinese and English databases from 2014 to October 31, 2022.
Of the 67 patients included, the median age was 72.5 years (range 34-86), including 44 males (65.7%). MG occurred in the median 2nd treatment cycle (range, 1st-6th) after nivolumab treatment, being mild in 12 patients (17.9%) and moderate to severe in 44 patients (65.7%). Ptosis (n = 48,71.6%), diplopia (n = 34,50.7%), dyspnea (n = 30, 44.8%), limb muscle weakness (n = 30, 44.8%) and dysphagia (n = 27, 40.3%) were the most common symptoms. Fifty-six patients (83.6%) were classified as having generalized myasthenia gravis (GMG), the remaining 11 patients (16.4%) isolated ocular myasthenia gravis (OMG). Twenty-one patients (31.3%) had MG combined with myositis, 10 patients (14.9%) had myocarditis, and 9 patients (13.4%) had both myositis and myocarditis. Forty patients (59.7%) were positive for anti-acetylcholine receptor antibodies. The serum creatine kinase level was significantly increased in 37 patients (55.2%), with a median value of 4000 IU/L (219,14229). After discontinuation of nivolumab and immunosuppressive therapy, 46 patients (68.7%) finally recovered or improved their MG symptoms, while 15 patients (22.4%) did not recover. Eleven patients (16.4%) died of MG complications.
MG is a serious and rare adverse reaction to nivolumab. Nivolumab-induced MG should be timely and correctly identified, and immunotherapy should be given.
探讨纳武利尤单抗所致重症肌无力（MG）的临床特征，为临床合理使用纳武利尤单抗提供依据。
通过检索2014年至2022年10月31日的中英文数据库，收集纳武利尤单抗所致MG的病例报告和病例系列进行回顾性分析。
纳入的67例患者中，中位年龄为72.5岁（范围34 - 86岁），其中男性44例（65.7%）。MG发生在纳武利尤单抗治疗后的中位第2个疗程（范围：第1 - 6个疗程），12例患者（17.9%）为轻度，44例患者（65.7%）为中度至重度。上睑下垂（n = 48，71.6%）、复视（n = 34，50.7%）、呼吸困难（n = 30，44.8%）、肢体肌肉无力（n = 30，44.8%）和吞咽困难（n = 27，40.3%）是最常见的症状。56例患者（83.6%）被归类为全身型重症肌无力（GMG），其余11例患者（16.4%）为单纯眼肌型重症肌无力（OMG）。21例患者（31.3%）MG合并肌炎，10例患者（14.9%）合并心肌炎，9例患者（13.4%）同时合并肌炎和心肌炎。40例患者（59.7%）抗乙酰胆碱受体抗体阳性。37例患者（55.2%）血清肌酸激酶水平显著升高，中位值为4000 IU/L（219，14229）。停用纳武利尤单抗和免疫抑制治疗后，46例患者（68.7%）最终MG症状恢复或改善，15例患者（22.4%）未恢复。11例患者（16.4%）死于MG并发症。
MG是纳武利尤单抗一种严重且罕见的不良反应。应及时、正确识别纳武利尤单抗所致MG，并给予免疫治疗。
