Open AccessSeronegative antibody‐mediated neurology after immune checkpoint inhibitors
Author(s) -
Wilson Robert,
Menassa David A.,
Davies Alexander J.,
Michael Sophia,
Hester Joanna,
Kuker Wilhelm,
Collins Graham P.,
Cossins Judith,
Beeson David,
Steven Neil,
Maddison Paul,
Rinaldi Simon,
Jacob Saiju,
Irani Sarosh R.
Publication year - 2018
Publication title -
annals of clinical and translational neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.824
H-Index - 42
ISSN - 2328-9503
DOI - 10.1002/acn3.547
Subject(s) - medicine , neurology , myasthenia gravis , transverse myelitis , antibody , autoantibody , nivolumab , immunology , adverse effect , guillain barre syndrome , autoimmunity , multiple sclerosis , immune system , immunotherapy , psychiatry
Abstract Checkpoint inhibitor medications have revolutionized oncology practice, but frequently induce immune‐related adverse events. During autoimmune neurology practice over 20 months, we prospectively identified four patients with likely antibody‐mediated neurological diseases after checkpoint inhibitors: longitudinally extensive transverse myelitis, Guillain–Barré syndrome, and myasthenia gravis. All patients shared three characteristics: symptoms commenced 4 weeks after drug administration, responses to conventional immunotherapies were excellent, and autoantibodies traditionally associated with their syndrome were absent. However, serum immunoglobulins from the myelitis and Guillain–Barré syndrome patients showed novel patterns of tissue reactivity. Vigilance is required for antibody‐mediated neurology after checkpoint inhibitor administration. This phenomenon may inform the immunobiology of antibody‐mediated diseases.