Quality and Patient Safety Articles-NM Complications of Immune Checkpoint Inhibitors

NM Complications of Immune Checkpoint Inhibitors

Pdf Summary

Neuromuscular complications have been associated with immune checkpoint inhibitors (ICPI’s), which are monoclonal antibodies used to treat various cancers by utilizing the patient's immune system. These complications occur in approximately 1-3% of patients treated with ICPI. Common neuromuscular complications include myasthenia gravis (both exacerbation and de novo), chronic inflammatory demyelinating polyneuropathy (CIDP), myositis, and non-length-dependent radiculoneuropathy. Overlap syndromes of myasthenia gravis and myositis are also seen.<br /><br />The management of these complications requires an interdisciplinary approach. The first step is usually stopping the causative agent, depending on the severity of the adverse effects. Beyond that, management is similar to when these complications are not associated with ICPI. Corticosteroids, IVIG, and plasmapheresis are commonly used treatments. Corticosteroids can be considered even in cases of Guillain-Barre syndrome (GBS), which is not traditionally treated with corticosteroids, because of their impact in reducing immune-mediated adverse effects of ICPI medications.<br /><br />Several articles support the information provided. These include studies by Dubey et al. (2019), Johansen et al. (2019), Kolb et al. (2018), and Psimaras et al. (2019). These studies discuss the varied phenotypes and management of ICPI-associated neuropathies, provide a systematic review of neuromuscular adverse events associated with anti-PD-1 monoclonal antibodies, and explore the pathogenesis and treatment of ICPI-induced neuromuscular toxicity.<br /><br />The summary highlights the association of neuromuscular complications with ICPI's, the specific complications involved, and the management strategies for these complications.

Keywords

Neuromuscular complications

Immune checkpoint inhibitors

Monoclonal antibodies

Cancer treatment

Myasthenia gravis

Chronic inflammatory demyelinating polyneuropathy

Myositis

Radiculoneuropathy

Overlap syndromes

Interdisciplinary approach

cidp