Clinical Issue of Myasthenia Gravis Related to Immune Checkpoint Inhibitors.

IF 4.7 2区 医学 Q1 ONCOLOGY Current Oncology Reports Pub Date : 2024-09-01 Epub Date: 2024-07-01 DOI:10.1007/s11912-024-01571-0
Kyoichi Kaira, Atsuto Mouri, Hisao Imai, Ou Yamaguchi, Hiroshi Kagamu
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Abstract

Purpose of review: Immune-related adverse events (irAEs) are pivotal in the management of immune checkpoint inhibitors (ICIs) across various human neoplasms. While common irAEs are manageable by oncologists, the detailed features of rare complications related to ICI therapy remain elusive. Among these, immune-related myasthenia gravis (irMG) stands out as a life-threatening disease.

Recent findings: Research articles published in English between 2017 and 2023 were identified using the PubMed database. Forty-six relevant research studies were examined to collate information for this review. The incidence of ICI-induced MG was found to be less than 1.0%, with approximately 20-30% of irMG patients presenting with overlap syndrome involving myocarditis and myositis. The detection of acetylcholine receptor antibodies (AChR-Ab) and elevated creatinine kinase (CK) levels proved useful in identifying 50-70% and 60-80% of cases, respectively. However, the utility of muscle-specific kinase antibodies (MuSK-Ab) in detecting irMG was limited due to a low positivity rate (0-5.3%). Ptosis emerged as the most common initial symptom of irMG, with an approximate positivity rate of 80%. Recommended treatment for irMG involves high-dose steroids in conjunction with plasmapheresis or immunoglobulins to mitigate the increased mortality associated with irMG. Early initiation of immunosuppressive therapy is imperative to prevent the worsening of irMG. Furthermore, facilitating a fulfilling social life post-hospitalization is crucial. This review sheds light on the clinical aspects and management strategies pertaining to irMG.

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与免疫检查点抑制剂相关的肌无力临床问题。
综述目的:免疫相关不良事件(irAEs)是治疗各种人类肿瘤的免疫检查点抑制剂(ICIs)的关键。虽然肿瘤学家可以处理常见的 irAEs,但与 ICI 治疗相关的罕见并发症的详细特征仍然难以捉摸。其中,免疫相关性肌无力(irMG)是一种威胁生命的疾病:使用 PubMed 数据库识别了 2017 年至 2023 年间发表的英文研究文章。研究人员对46项相关研究进行了审查,为本综述整理了相关信息。研究发现,ICI诱发的MG发病率低于1.0%,约20-30%的irMG患者会出现心肌炎和肌炎重叠综合征。乙酰胆碱受体抗体(AChR-Ab)的检测和肌酸激酶(CK)水平的升高分别有助于鉴别 50-70% 和 60-80% 的病例。然而,由于阳性率较低(0-5.3%),肌肉特异性激酶抗体(MuSK-Ab)在检测虹膜血管内皮癌方面的作用有限。上睑下垂是虹膜麦格病最常见的初期症状,阳性率约为 80%。推荐的虹膜血管内皮生长因子治疗包括大剂量类固醇与浆细胞分离或免疫球蛋白,以降低与虹膜血管内皮生长因子相关的死亡率。必须尽早开始免疫抑制治疗,以防止虹膜转移性心肌病恶化。此外,促进患者在出院后过上充实的社会生活也至关重要。本综述介绍了有关虹膜格氏病的临床方面和管理策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.50
自引率
0.00%
发文量
187
审稿时长
6-12 weeks
期刊介绍: This journal aims to review the most important, recently published clinical findings in the field of oncology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care of those affected by cancer. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as cancer prevention, leukemia, melanoma, neuro-oncology, and palliative medicine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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