Myasthenia gravis (MG) is a rare but life-threatening adverse event with pembrolizumab. What is known about pembrolizumab-induced MG is largely based on case reports. This analysis collected pembrolizumab-induced MG cases from Chinese and English databases published from September 1, 2014, to June 30, 2022. Demographic and clinical information of the patients, management, and outcome data were collected and analyzed. Sixty-five patients with a median age of 73 years (range 30-86), including 43 male patients (66.2%), were included. Eight patients (12.3%) with prior MG experienced worsening symptoms after receiving pembrolizumab. The median time to the onset of MG was four weeks (range 0.7-27). The most common symptoms were ptosis (81.5%, 53 patients), diplopia (50.8%, 33 patients), dyspnea (44.6%, 29 patients), trunk or peripheral weakness (43.1%, 28 patients), and dysphagia (30.8%, 20 patients). Concurrent myositis and myocarditis occurred in 13 (20.0%) and 17 patients (26.2%). Pembrolizumab was discontinued in 63 patients (96.9%). Forty-four patients (67.7%) received combination therapies based on steroids (intravenous immune globulin, plasmapheresis, or immunosuppressants). Twenty-seven patients (41.5%) had symptoms completely recovered. Fourteen patients (21.5%) died from immunotoxicity or primary cancers. Clinicians should consider the possibility of pembrolizumab-induced MG, especially during the first eight weeks of therapy. Patients should be treated as early as possible, regardless of the severity of the initial symptoms.

中文翻译：

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帕博利珠单抗诱导的重症肌无力的临床特征、诊断和治疗。

重症肌无力 (MG) 是派姆单抗的一种罕见但危及生命的不良事件。关于派姆单抗诱发的 MG 的了解主要基于病例报告。该分析从2014年9月1日至2022年6月30日发布的中文和英文数据库中收集了派姆单抗诱发的MG病例。收集并分析了患者的人口统计学和临床​​信息、管理和结果数据。纳入的 65 名患者中位年龄为 73 岁（范围 30-86 岁），其中包括 43 名男性患者（66.2%）。8 名既往患有 MG 的患者 (12.3%) 在接受派姆单抗治疗后症状恶化。重症肌无力发病的中位时间为 4 周（范围 0.7-27）。最常见的症状是上睑下垂（81.5%，53 名患者）、复视（50.8%，33 名患者）、呼吸困难（44.6%，29 名患者）、躯干或周围无力（43.1%，28 名患者）和吞咽困难（30.8%， 20 名患者）。并发肌炎和心肌炎的患者分别为 13 例（20.0%）和 17 例（26.2%）。63 名患者 (96.9%) 停用派姆单抗。44 名患者 (67.7%) 接受了基于类固醇的联合治疗（静脉注射免疫球蛋白、血浆置换或免疫抑制剂）。27 名患者（41.5%）的症状完全康复。14 名患者（21.5%）死于免疫毒性或原发性癌症。临床医生应考虑帕博利珠单抗诱发 MG 的可能性，尤其是在治疗的前八周内。无论初始症状的严重程度如何，患者都应尽早接受治疗。