Treatment of Drug-induced Myopathy with Severe Functional Impairment in Immune Checkpoint Inhibitor Use

Clinical Scenario

Severe presentation

This protocol applies to drug-induced myopathy arising during immune checkpoint inhibitor (ICI) therapy when one or more of the following high-risk features is present:

Severe functional impairment — swallowing disorders, myocarditis, or involvement of respiratory or laryngeal muscles
Major creatine phosphokinase (CPK) elevation
Myasthenia gravis–like features

Treatment Approach (Partial Overview)

In this setting, management begins with definitive discontinuation of the immune checkpoint inhibitor and prompt escalation to aggressive immunomodulatory therapy — of which high-dose corticosteroids form one component. The complete treatment algorithm, escalation criteria, and additional intervention options are available in the full structured protocol.

Full regimen not shown here — access via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.3390/biomedicines12050987

However, clinical syndromes with severe functional impairment (including swallowing disorders, myocarditis, and involvement of respiratory or laryngeal muscles, among others), and a major increase in CPK and/or myasthenia features, warrant definite ICI discontinuation and more aggressive treatment, including high-dose steroids, plasma exchange, intravenous immunoglobulin (IVIG), and immunosuppressants.

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