Overt Myasthenia Gravis Developing During Immune Checkpoint Inhibitor Treatment
Immune checkpoint inhibitors can give rise to overt myasthenia gravis as an immune-related adverse event. This sub-population presents distinct clinical features and carries an urgent management need.
Clinical Scenario
High-risk presentationOvert myasthenia gravis arising in patients currently receiving immune checkpoint inhibitor therapy. ICI-associated MG is generally severe, with a high rate of respiratory crises — prompt recognition and intervention are critical.
Treatment Approach
This presentation calls for early, aggressive intervention. High-dose corticosteroid therapy forms a core element of management — the full protocol specifies the complete regimen, including additional treatment modalities and their sequencing.
Clinical Goal
Resolution or improvement of myasthenia gravis symptoms.
References
DOI: 10.1212/WNL.0000000000011124
- Early aggressive treatment with high-dose steroids in combination with plasma exchange or IVIg may be required in patients who develop overt MG while on ICIs.
- MG associated with ICIs is generally severe, with a high rate of respiratory crises.
- MG symptoms completely resolved in 12 patients (19%), improved in 34 (55%), and worsened in 16 (26%).