Select cases of severe myositis associated with CTLA-4 and/or PD-1 axis inhibitors

Drug(s)Description↑CK?ASM IgG?Onset (wks)TreatmentTrialReference
Ipilimumab + nivolumabPolymyositis with respiratory involvementYesYes3Corticosteroid, infliximab, IVIG, PexNCT01928394[35]
NivolumabMyositis with respiratory failureYes7Corticosteroid[36]
NivolumabMyasthenia crisis and polymyositis requiring ventilationYesNo2Corticosteroid, Pex, IVIG pyridostigmine[19]
PembrolizumabPolyarticular tenosynovitis and proximal myositisNo56SulfasalazineNCT01295827[37]
PembrolizumabExacerbation of preexisting myositisYes1IVIG[38]
IpilimumabDermatomyositisYes2Corticosteroid[39]
Pembrolizumab / ipilimumabRhabdomyolysis associated with hypothyroidismYes6Levothyroxine[40]
IpilimumabCombined myasthenia and myositis with AChRYesYes7Corticosteroid, IVIG[26]
IpilimumabRetrobulbar weakness with proximal myositis.YesYes7Corticosteroid, IVIG[3]
IpilimumabOrbital myositis associated with ipilimumab12Corticosteroid[41]
Tremelimumab + durvalumabDescribed in text.NoYes4Corticosteroid, Pex, IVIGNCT02000947

Abbreviations: ASM, anti-striated muscle antibody, NCT national clinical trials identifier number, Pex plasma exchange, IVIG intravenous immunoglobulin G, AChR acetylcholine receptor antibody, CK creatine kinase, wks weeks