{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T05:38:16Z","timestamp":1791005896248,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T00:00:00Z","timestamp":1704931200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction\/Aims<\/jats:title><jats:p>Myasthenia gravis (MG) is a rare, life\u2010threatening immune\u2010related adverse effect (irAE) of immune checkpoint inhibitor (ICI) treatment. C5\u2010complement inhibitors are effective treatments for acetylcholine receptor antibody (AChR ab) positive generalized MG. We describe the use of eculizumab\/ravulizumab in two patients with MG\u00a0receiving concomitant pembrolizumab.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective review of two medical records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patient 1: An 80\u2010year\u2010old male with recurrent, non\u2010muscle invasive transitional cell carcinoma of the bladder developed ICI\u2010induced AChR ab positive MG (ICI\u2010MG), myositis, and myocarditis 2\u2009weeks after the first dose of pembrolizumab. Myositis responded to corticosteroids. MG responded to eculizumab, followed by ravulizumab. He died of metastatic cancer 8\u2009months later. Patient 2: A 58\u2010year\u2010old male had refractory thymoma\u2010associated AChR ab\u2010positive MG, which responded to eculizumab. He developed metastatic Merkel cell cancer necessitating pembrolizumab. MG remained stable on eculizumab. He had no irAEs for 22\u2009months, with positron emission tomographic resolution of cancer. He then developed mild, indolent retinal vasculitis, which responded to prednisone. Discontinuation of pembrolizumab for 5\u2009months resulted in cancer recurrence; pembrolizumab was resumed with peri\u2010infusion pulse prednisone. MG remained stable and he continues eculizumab.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>In the first patient, eculizumab, followed by ravulizumab, improved ICI\u2010MG. In the second patient, eculizumab treatment may have had a prophylactic effect on the development of ICI\u2010induced irAEs. The effect of complement inhibition on cancer outcomes of ICI therapy is unknown. A possible biologic basis for complement inhibitors in reducing irAEs of ICI, especially in the presence of underlying autoimmune disease, merits evaluation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mus.28037","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T12:25:38Z","timestamp":1704975938000},"page":"368-372","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Novel uses of complement inhibitors in myasthenia gravis\u2014<scp>Two<\/scp> case reports"],"prefix":"10.1002","volume":"69","author":[{"given":"Sean","family":"Zadeh","sequence":"first","affiliation":[{"name":"Department of Neurology Beth Israel Deaconess Medical Center\/Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Price","sequence":"additional","affiliation":[{"name":"Department of Neurology Beth Israel Deaconess Medical Center\/Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reed","family":"Drews","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology Beth Israel Deaconess Medical Center\/Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Bouffard","sequence":"additional","affiliation":[{"name":"Department of Neurology Beth Israel Deaconess Medical Center\/Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy H.","family":"Young","sequence":"additional","affiliation":[{"name":"Retina Services Massachusetts Eye and Ear Infirmary\/Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9412-7349","authenticated-orcid":false,"given":"Pushpa","family":"Narayanaswami","sequence":"additional","affiliation":[{"name":"Department of Neurology Beth Israel Deaconess Medical Center\/Harvard Medical School  Boston Massachusetts 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