Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Neuromuscular adverse events associated with anti-PD-1 monoclonal antibodies: Systematic review

Research output: Contribution to journalReviewResearchpeer-review

  1. Fat oxidation is impaired during exercise in lipin-1 deficiency

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Declining malformation rates with changed antiepileptic drug prescribing: An observational study

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Clinical spectrum of STX1B-related epileptic disorders

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Electromagnetic source imaging in presurgical workup of patients with epilepsy: A prospective study

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Refining the spinobulbar muscular atrophy phenotype by quantitative MRI and clinical assessments

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Skull base versus non-skull base meningioma surgery in the elderly

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Rare cause of spontaneous haemothorax: mediastinal and distant lymph node metastases from uveal melanoma

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Acute endovascular reperfusion treatment in patients with ischaemic stroke and large-vessel occlusion (Denmark 2011–2017)

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Semiology and Mechanisms of Near-Death Experiences

    Research output: Contribution to journalReviewResearchpeer-review

  5. Fatal kakeksi ved mitokondriel neurogastrointestinal encefalomyopati.

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

Neuromuscular adverse events following cancer treatment with anti-programmed cell death protein 1 (PD-1) monoclonal antibodies are relatively rare, yet potentially fatal. We performed a systematic review to characterize the clinical presentation, diagnostic workup, and management of neuromuscular disorders (NMDs) in patients treated with nivolumab or pembrolizumab monotherapy or concurrent with other immunologic agents, such as ipilimumab. Sixty-one publications on 85 patients (mean age 66.9 years [range 34-86]; male/female 2.6:1; 59% metastatic melanoma) were identified from selected indexing databases until June 2018. Forty-eight patients had received nivolumab and 39 pembrolizumab. The mean number of PD-1 inhibitor treatment cycles prior to onset of symptoms was 3.6 (range 1-28). Symptoms included oculomotor (47%), respiratory (43%), bulbar (35%), and proximal weakness (35%), as well as muscle pain (28%). Diagnoses were categorized as myasthenia gravis (27%), neuropathy (23%), myopathy (34%), or a combination of these (16%). After a critical review of the data, however, evidence did not support the stated NMD diagnosis in 13% of cases, while up to 25% of patients had signs of additional NMDs. Cardiac complications occurred in more than 30% of patients diagnosed with myasthenia gravis or myositis. Mortality was high in these patients, despite adequate treatment strategies including corticosteroid, IV immunoglobulins, and plasma exchange. The clinical presentation of NMDs associated with PD-1 inhibitors is often atypical, with considerable overlap between myasthenia gravis and myopathy, and cardiac/respiratory complications are common.

Original languageEnglish
JournalNeurology
Volume92
Issue number14
Pages (from-to)663-674
Number of pages12
ISSN0028-3878
DOIs
Publication statusPublished - 2 Apr 2019

ID: 58247137