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免疫检查点抑制剂度伐利尤单抗与重症肌无力之间的关联:一项综述

Association Between the Immune Checkpoint Inhibitor Durvalumab and Myasthenia Gravis: A Comprehensive Review.

作者信息

Bector Gaurav, Trehan Shubam, Toofantabrizi Mahyar, Singh Gurjot, Jain Aayush, Arora Nirav, Shrestha Suchitra, Panjwani Gianeshwaree Alias Rachna, Jain Prateek, Kalra Eva

机构信息

Medicine and Surgery, Dayanand Medical College and Hospital, Ludhiana, IND.

Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND.

出版信息

Cureus. 2024 Sep 3;16(9):e68542. doi: 10.7759/cureus.68542. eCollection 2024 Sep.

Abstract

Immune checkpoint inhibitors (ICIs), including Imfinzi (durvalumab), have revolutionized cancer treatment by stimulating the body's immune system to target cancerous cells. Although pharmaceuticals offer therapeutic benefits, several drugs have been associated with immune-related adverse events (irAEs), including the uncommon but serious condition known as myasthenia gravis (MG). This review synthesizes data from pertinent research to offer a thorough evaluation of the literature on the underlying mechanisms, clinical manifestations, and therapeutic approaches for durvalumab-induced MG. The incidence of MG in patients on durvalumab and other ICIs is typically low, with less than 1% documented, despite the potential for severe problems associated with the disease. Durvalumab disrupts immunological tolerance by stimulating autoreactive T-cells and inducing the production of autoantibodies. The clinical consequences of MG need meticulous monitoring, prompt identification, and suitable management to efficiently control the condition. Medical practitioners must carefully weigh the positive effects of ICIs against the possible hazards, emphasizing the necessity for more extensive investigation to improve patient results and establish uniform treatment protocols.

摘要

免疫检查点抑制剂(ICIs),包括英飞凡(度伐利尤单抗),通过刺激人体免疫系统靶向癌细胞,彻底改变了癌症治疗方式。尽管药物具有治疗益处,但几种药物已与免疫相关不良事件(irAEs)相关联,包括罕见但严重的重症肌无力(MG)。本综述综合了相关研究的数据,对度伐利尤单抗诱导的MG的潜在机制、临床表现和治疗方法的文献进行了全面评估。尽管度伐利尤单抗和其他ICIs相关的MG疾病可能会引发严重问题,但接受这些药物治疗的患者中MG的发病率通常较低,记录在案的不到1%。度伐利尤单抗通过刺激自身反应性T细胞和诱导自身抗体的产生来破坏免疫耐受。MG的临床后果需要精心监测、及时识别和适当管理,以有效控制病情。医生必须仔细权衡ICIs的积极作用与可能的危害,强调需要进行更广泛的研究,以改善患者预后并建立统一的治疗方案。

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