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Abstract Details

High Rates of Myasthenia Gravis Exacerbations in Individuals With Pre-existing Myasthenia Gravis Exposed to Immune Checkpoint Inhibitors
Neuromuscular and Clinical Neurophysiology (EMG)
P11 - Poster Session 11 (11:45 AM-12:45 PM)
9-021
To determine outcomes in people with myasthenia gravis (pwMG) after exposure to immune checkpoint inhibitors (ICIs) for comorbid oncologic indications
ICIs are associated with immune-related adverse events (irAEs) including de novo myasthenia gravis and exacerbation of pre-existing autoimmune diseases.

PwMG treated with ICIs for comorbid oncologic indications were identified by systematic retrospective chart review at 17 tertiary medical centers and outcomes were obtained using a structured data instrument.

We identified 38 individuals (68% male; 16 AChR+, 1 MuSK+, 6 seronegative, and 8 unknown antibody status) with pre-existing MG who were treated with ICIs. Median age at time of ICI initiation was 75 years old. Fifteen pwMG (40%; 13 AChR+, 1 MuSK+, and 2 unknown) were diagnosed with a post-ICI MG exacerbation with a median onset of 63 days from first ICI dose. All MG exacerbations occurred while patients were on ICI therapy. Six MG exacerbations resolved with outpatient treatment; 7 resolved after treatment requiring hospital admission, including 3 ICU admissions and 1 intubation; and 2 ended with death. Three of the 7 patients with outpatient MG exacerbations were continued/restarted on ICI subsequently without further MG exacerbations. Myositis and myocarditis co-occurred with MG exacerbation in 4 and 3 patients, respectively. Both deaths associated with post-ICI MG exacerbations had concomitant myositis, one also with myocarditis. Fourteen pwMG (37%) were continued on MG immune therapies (azathioprine, mycophenolate, rituximab, or corticosteroids) after ICI initiation including 7 individuals who developed MG exacerbations. Excluding myositis and myocarditis, 2 pwMG (5.2%) had non-MG neurologic irAEs and 10 (26%) had non-neurologic irAEs. Seven subjects (18%) had full remission of their cancer at time of chart review.
In this retrospective cohort study of individuals with pre-existing MG, MG exacerbations following ICI treatment for comorbid cancer were common and, in some patients, associated with myositis, myocarditis, and severe clinical outcomes. 
Authors/Disclosures
Alexander J. Gill, MD, PhD
PRESENTER 		Dr. Gill has received personal compensation for serving as an employee of Novartis Pharmaceuticals Corporation. Dr. Gill has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medical Logix, LLC. Dr. Gill has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Health Union, LLC . Dr. Gill has received research support from National Multiple Sclerosis Society. Dr. Gill has a non-compensated relationship as a President, Treasurer, and Member of Board of Directors with Autoimmune Neurology Research Consortium, Inc. that is relevant to AAN interests or activities.
Jonathan Krett, MD Dr. Krett has nothing to disclose.
Carrie Li, MD (Carrie Li) Dr. Li has nothing to disclose.
Lyndsey Babcock, MD Dr. Babcock has nothing to disclose.
Yoav Piura, MD Dr. Piura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Piura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck.
Andrew Morrison, MD (Hospital of the University of Pennsylvania) Dr. Morrison has nothing to disclose.
Thomas J. Pisano, MD, PhD The institution of Dr. Pisano has received research support from NIH.
Cory K. Dodson, MD (Stanford Neurology) Dr. Dodson has nothing to disclose.
Atika Paracha, MBBS Dr. Paracha has nothing to disclose.
Anna Kaiser, DO Dr. Kaiser has nothing to disclose.
Said Alhassan, BS Mr. Alhassan has nothing to disclose.
Nikhil Modak, MD Dr. Modak has nothing to disclose.
Iwalewa Moninuola, MD Dr. Moninuola has nothing to disclose.
Maxime Jean, MD, PhD (University of Rochester Medical Center) Dr. Jean has nothing to disclose.
Jordan Carrier, MD (Corewell Health) Dr. CARRIER has nothing to disclose.
Muhammed Ikbal Arvas, MD (OU Health) Dr. Arvas has nothing to disclose.
Wendy A. Stewart, MD, PhD, FRCP No disclosure on file
Jessica Lamb, CRA Ms. Lamb has nothing to disclose.
María Paula Aguilera Peña, MD María Paula Aguilera Peña, MD has nothing to disclose.
Celeste R. Camargo, MD Dr. Camargo has nothing to disclose.
Vikram Bhise, MD (Rutgers - Robert Wood Johnson Medical School) Dr. Bhise has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cycle Pharmaceuticals. The institution of Dr. Bhise has received research support from Horizon Blue Cross Blue Shield.
Vinay Chaudhry, MD, FAAN Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care.
Jenny Linnoila, MD, PhD (University Neurology Associates, UPMC) Dr. Linnoila has received personal compensation in the range of $10,000-$49,999 for serving as a expert respondent on autoimmune encephalitis with U.S. government/DHHS/Vaccine Injury Compensation Program.
Kottil W. Rammohan, MD (University of Miami) Dr. Rammohan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Rammohan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Rammohan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Rammohan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Rammohan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genzyme. Dr. Rammohan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. The institution of Dr. Rammohan has received research support from Genentech. The institution of Dr. Rammohan has received research support from Genzyme. The institution of Dr. Rammohan has received research support from EMD Serono. The institution of Dr. Rammohan has received research support from Alexion.
Flavia Nelson, MD (University of Miami, Miller School of Medicine) Dr. Nelson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Brystol Meyer Squib. Dr. Nelson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Nelson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Nelson has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Genetech. The institution of Dr. Nelson has received research support from NIH. Dr. Nelson has received research support from Novartis.
Shamik Bhattacharyya, MD, FAAN (Brigham and Women's Hospital) Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NeuroLambda. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Merck. The institution of Dr. Bhattacharyya has received research support from Alexion Pharmaceuticals. The institution of Dr. Bhattacharyya has received research support from National Institute of Health. The institution of Dr. Bhattacharyya has received research support from UCB. The institution of Dr. Bhattacharyya has received research support from Genentech. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care.
Meabh O'Hare, MD (Brigham & Women's Hospital) Dr. O'Hare has nothing to disclose.
Ricardo Roda, MD, PhD (Johns Hopkins University) Dr. Roda has nothing to disclose.
Nicole Baldwin, MD Dr. Baldwin has received personal compensation in the range of $500-$4,999 for serving as a volunteer international neurology instructor with CMDA, MAP International, and INMED (NGOs).
Patricia K. Coyle, MD, FAAN (SUNY At Stony Brook) Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Accordant. Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Coyle has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sanofi Genzyme. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GlaxoSmithKline. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon Therapeutics. The institution of Dr. Coyle has received research support from CorEvitas LLC. The institution of Dr. Coyle has received research support from Genentech/Roche. The institution of Dr. Coyle has received research support from NINDS. The institution of Dr. Coyle has received research support from Sanofi Genzyme. The institution of Dr. Coyle has received research support from Cleveland Clinic.
Lauryn Hemminger (Strong Memorial Hospital) Dr. Hemminger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion.
Alexandra C. Simpson, MD (Johns Hopkins Hospital) Dr. Simpson has received research support from National MS Society.
Paula Barreras, MD (Cedars-Sinai Medical Center) Dr. Barreras has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Barreras has received research support from Foundation for Sarcoidosis Research. The institution of Dr. Barreras has received research support from 好色先生.
Irena Dujmovic Basuroski, MD, PhD (University of North Carolina At Chapel Hill) The institution of Dr. Dujmovic Basuroski has received research support from Alexion Pharmaceuticals, Inc. The institution of Dr. Dujmovic Basuroski has received research support from Biogen MA Inc. The institution of Dr. Dujmovic Basuroski has received research support from EMD Serono Research and Development Institute, Inc . The institution of Dr. Dujmovic Basuroski has received research support from Celgene Corporation/Bristol-Myers Squibb. The institution of Dr. Dujmovic Basuroski has received research support from The Bodford Family Transverse Myelitis Center Fund. The institution of Dr. Dujmovic Basuroski has received research support from CorEvitas, LLC. The institution of Dr. Dujmovic Basuroski has received research support from Novartis. The institution of Dr. Dujmovic Basuroski has received research support from Ad Scientiam. Dr. Dujmovic Basuroski has received personal compensation in the range of $0-$499 for serving as a Travel -related expenses to attend clinical trial investigator meeting with Novartis. Dr. Dujmovic Basuroski has received personal compensation in the range of $500-$4,999 for serving as a International Clinical Consortium Member, Travel -related expenses to attend the meeting with The Guthy-Jackson Charitable Foundation.
Anne G. Douglas, MD Dr. Douglas has nothing to disclose.
Cole A. Harrington, MD, PhD (The Ohio State University) Dr. Harrington has nothing to disclose.
George J. Hutton, MD, FAAN (Baylor College of Medicine) Dr. Hutton has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Autoimmunity Biologic Solutions, Inc.. The institution of Dr. Hutton has received research support from Biogen. The institution of Dr. Hutton has received research support from Genentech. The institution of Dr. Hutton has received research support from Genzyme.
Kristin M. Galetta, MD (Stanford University) Dr. Galetta has received personal compensation in the range of $0-$499 for serving as a Speaker with Can Do MS.
Gregory S. Day, MD, MSc, FAAN (Mayo Clinic) Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for DynaMed (EBSCO Health). Dr. Day has or had stock in ANI Pharmaceuticals. The institution of Dr. Day has received research support from National Institutes of Health / NIA. The institution of Dr. Day has received research support from National Institutes of Health / NINDS. The institution of Dr. Day has received research support from Amgen Pharmaceuticals. The institution of Dr. Day has received research support from AVID Radiopharmaceuticals. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Presenter at Annual Meeting (CME) with 好色先生. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Content Development (CME) with PeerView, Inc. Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Content Development (CME) with Continuing 好色先生, Inc. Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Content Development (CME) with Ionis Pharmaceuticals. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a 好色先生al Case Development + Presentation (video) with PeerDirect (P\S\L Group). Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Content Development / Presentation (non-CME) with MJH Life Sciences (NeurologyLive). Dr. Day has a non-compensated relationship as a Clinical Director with Anti-NMDA Receptor Encephalitis Foundation that is relevant to AAN interests or activities.
Sarah Conway, MD (BWH) Dr. Conway has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurology Live.
Shuvro Roy, MD (University of Washington) Dr. Roy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Roy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Roy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Roy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Roy has received research support from The Siegel Rare Neuroimmune Association.
Sachin Gadani, MD, PhD (Johns Hopkins) Dr. Gadani has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. The institution of Dr. Gadani has received research support from National MS Society.
Andrew Wolf, MD The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. The institution of Dr. Wolf has received research support from Genentech. The institution of Dr. Wolf has received research support from Rocky Mountain MS Center. The institution of Dr. Wolf has received research support from Michael J. Fox Foundation. Dr. Wolf has received publishing royalties from a publication relating to health care.
John Probasco, MD, FAAN (The Johns Hopkins Hospital) Dr. Probasco has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Clinician. The institution of Dr. Probasco has received research support from Roche/Genentech.