Immune Checkpoint Inhibitor-Induced Myositis: a Case Report and Literature Review
Purpose of the Review
We clarify clinical characteristics of patients with immune checkpoint inhibitor (ICI)-induced myositis.
In 13 of 15 cases with ICI-induced myositis, the type of malignancy was melanoma. Eight, 4, and 3 patients received anti-PD-1 alone, anti-CTLA4 alone, and a combination of those, respectively. The mean period to the onset of ICI-induced myositis from the initiation of ICI was 4 weeks. Myocarditis was a complication in five patients. Seven of the patients died. The causes of death were myocarditis in three patients, respiratory muscle paralysis in two patients, and cancer progression in two patients. In patients without myocarditis or respiratory muscle paralysis, the prognosis for myositis was favorable with normalization of the CK levels occurring upon the cessation of ICI and the administration of immunosuppressive agents.
Myocarditis and respiratory muscle paralysis are the major causes of death as immune-related adverse events in patients with ICI-induced myositis.
KeywordsImmune checkpoint inhibitor Programed cell death-1 Cytotoxic T lymphocyte antigen 4 Autoreactive T cell Myositis
This study was supported in part by research grants for intractable diseases of Autoimmune Diseases from the Ministry of Health, Labour and Welfare, Japan.
Compliance with Ethical Standards
Conflict of Interest
The authors declare no conflicts of interest in this work. Outside the submitted work, Kadota H, Shirai Y, and Okazaki Y have nothing to disclose. Gono T, Takeno M, and Kuwana M have relevant financial activities outside the submitted work as follows: Gono T, personal fees from Astellas Pharma, personal fees from Chugai Pharmaceutical, personal fees from Daiichi sankyo, personal fees from Janssen Pharmaceutical, personal fees from Mitsubishi Tanabe Pharma, personal fees from Ono Pharmaceutical; Takeno M, personal fees from Celgene, personal fees from Tanabe-Mitsubishi, Co, personal fees from Eizai, Abbbie, grants from Novortis; Kuwana M, grants and personal fees from Chugai Pharmaceutical, grants and personal fees from Mitsubishi Tanabe Pharma, grants and personal fees from Ono Pharmaceutical, grants and personal fees from Pfizer, personal fees from Janssen Pharmaceutical, grants and personal fees from Astellas Pharma, grants and personal fees from Esai, personal fees from Boehringer Ingelheim, personal fees from Bayer, personal fees from Corbus, personal fees from Reata.
Ethics Approval and Consent to Participate
This study was approved by the ethics committee of Nippon Medical School Hospital (approval number 28-12-680) and was conducted in accordance with the Declaration of Helsinki. Our patient provided informed consent to participate in this study and consent for the use of the data.
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