Immune checkpoint inhibition in patients with inactive pre-existing neuromuscular autoimmune diseases

Objectives: To evaluate the safety of immune checkpoint inhibitor use in patients with pre-existing neurological autoimmune diseases. Methods: In this retrospective case-series, we examined exacerbations of underlying disease and the occurrence of immune-related adverse events in 5 patients who had been diagnosed with a neurological autoimmune disease prior to receiving immune checkpoint inhibitor therapy for advanced malignancy. Results: Two patients had a prior diagnosis of myasthenia gravis, two had Guillain-Barre syndrome, and one had chronic idiopathic demyelinating polyneuropathy. Only one patient experienced a flare of neurological autoimmune disease. Four of the five patients experienced immune-related adverse events unrelated to their neurological disease. Conclusions: In this case-series, exacerbations of neurological autoimmune disease were less common and less severe than expected. Further research is needed to determine which individuals are at greatest risk of neurological autoimmune disease complication while receiving immune checkpoint inhibitor therapy.