2026 American Academy of Neurology Abstract Website

Alexander Gill¹, Jonathan Krett², Carrie Li³, Lyndsey Babcock⁴, Yoav Piura⁵, Andrew Morrison⁶, Thomas Pisano⁶, Cory Dodson⁷, Atika Paracha⁸, Anna Kaiser⁹, Said Alhassan¹⁰, Nikhil Modak¹¹, Iwalewa Moninuola¹¹, Maxime Jean¹², Jordan CARRIER¹², Muhammed Ikbal Arvas¹³, Wendy Stewart¹⁴, Jessica Lamb¹⁵, Maria Aguilera-Pena¹⁶, Celeste Camargo¹⁷, Vikram Bhise¹⁷, Vinay Chaudhry¹⁰, Jenny Linnoila⁹, Kottil Rammohan¹⁸, Flavia Nelsion¹⁸, Shamik Bhattacharyya³, Meabh O'Hare³, Ricardo Roda², Nicole Baldwin¹⁸, Patricia Coyle¹⁵, Lauryn Hemminger¹², Alexandra Simpson¹⁴, Paula Barreras¹⁶, Irena Dujmovic Basuroski¹⁰, Anne Douglas⁶, Cole Harrington¹¹, George Hutton¹³, Kristin Galetta⁷, Gregory Day⁵, Sarah Conway³, Shuvro Roy⁸, Sachin Gadani⁹, Andrew Wolf⁴, John Probasco²
¹Autoimmune Neurology Research Consortium (ANRC), ²Department of Neurology, Johns Hopkins School of Medicine, ³Department of Neurology, Mass General Brigham, ⁴Department of Neurology, University of Colorado School of Medicine, ⁵Department of Neurology, Mayo Clinic, ⁶Department of Neurology, Hospital of the University of Pennsylvania, ⁷Department of Neurology, Stanford University, ⁸Department of Neurology, University of Washington, ⁹Department of Neurology, University of Pittsburgh, ¹⁰Department of Neurology, University of North Carolina School of Medicine, ¹¹Department of Neurology, The Ohio State University Wexner Medical Center, ¹²Department of Neurology, University of Rochester Medical Center, ¹³Department of Neurology, Baylor College of Medicine, ¹⁴Department of Neurology, University of Virginia School of Medicine, ¹⁵Department of Neurology, Stony Brook Medicine, ¹⁶Department of Neurology, Cedars-Sinai Medical Center, ¹⁷Department of Neurology, Rutgers-Robert Wood Johnson Medical Schoo, ¹⁸Department of Neurology, University of Miami

Objective:

To determine outcomes in people with myasthenia gravis (pwMG) after exposure to immune checkpoint inhibitors (ICIs) for comorbid oncologic indications

Background:

ICIs are associated with immune-related adverse events (irAEs) including de novo myasthenia gravis and exacerbation of pre-existing autoimmune diseases.

Design/Methods:

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.

Results:

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.

Conclusions:

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.