Immune checkpoint inhibitor-induced myositis, the earliest and most lethal complication among rheumatic and musculoskeletal toxicities
In addition to restoring anti-tumor immune responses, immune checkpoint inhibitors (ICI) may also induce immune-related adverse events (irAE) that can affect any organ. We aim to determine the spectrum, timing, clinical features, and fatalities of rheumatic and musculoskeletal immune-related adverse...
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| Veröffentlicht in: | Autoimmunity reviews 2020-08, Vol.19 (8), p.102586, Article 102586 |
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| creator | Allenbach, Yves Anquetil, Céline Manouchehri, Ali Benveniste, Olivier Lambotte, Olivier Lebrun-Vignes, Bénédicte Spano, Jean-Philippe Ederhy, Stéphane Klatzmann, David Rosenzwajg, Michelle Fautrel, Bruno Cadranel, Jacques Johnson, Douglas B. Moslehi, Javid J. Salem, Joe-Elie |
| description | In addition to restoring anti-tumor immune responses, immune checkpoint inhibitors (ICI) may also induce immune-related adverse events (irAE) that can affect any organ. We aim to determine the spectrum, timing, clinical features, and fatalities of rheumatic and musculoskeletal immune-related adverse events (RMS-irAE) associated with ICI.
We performed an observational, retrospective, pharmacovigilance study using the World Health Organization international pharmacovigilance database, VigiBase, from inception to January 2019. RMS-irAE reporting rate on ICI versus full database was performed using disproportionality analysis with computation of reporting-odds-ratios (ROR) and a Bayesian disproportional estimate (information component, IC). IC025 (lower end of the IC 95% credibility interval) >0 is deemed significant.
We identified 1288 RMS-irAE significantly associated with ICI: polymyalgia rheumatica (n = 76, ROR = 14.6 [11.6–18.4], IC025 = 3.34), sarcoidosis (n = 94; ROR = 9.6 [7.9–11.9]; IC025 = 2.85), Sjogren's syndrome (n = 49; ROR = 6.9 [5.2–9.2]; IC025 = 2.24), myositis (n = 465; ROR = 4.9 [4.5–5.4]; IC025 = 2.12), arthritis (n = 606; ROR = 1.4 [1.3–1.5]; IC025 = 0.34) and scleroderma (n = 17; ROR = 2.0 [1.2–3.2]; IC025 = 0.17). Arthritis, myositis, and Sjogren's syndrome were over-reported in patients treated with ICI combination versus those treated with ICI monotherapy (ROR = 1.6–2.9, p |
| doi_str_mv | 10.1016/j.autrev.2020.102586 |
| format | Article |
| fullrecord | <record><control><sourceid>elsevier_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_04003010v2</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1568997220301506</els_id><sourcerecordid>S1568997220301506</sourcerecordid><originalsourceid>FETCH-LOGICAL-c559t-fe01228c8cb73ef6fa2eb18c41d8bc16ac72ce572b41de31474459aa9ea71e443</originalsourceid><addsrcrecordid>eNp9kctq3TAQhkVJaS7tG5SibSA-lWT5timEkBsc6KZdC3k8rufEtg6SfEheoM9dHZyGrrrS8Ov_ZqT5GfssxUYKWX7dbewSPR42SqijpIq6fMfOZFHWWdNU6uSf-pSdh7ATCWtU84Gd5qrIC9HoM_b7cZqWGTkMCE97R3PkNA_UUnQ-o7lbADs-vbhAkcIVjwNytH4kDJHbOV25VIwYBztycNN-JLCR3Mzt5OZf3A-4TEmA1bwEWEYXnjARCYjumSA1xvCRve_tGPDT63nBft7d_rh5yLbf7x9vrrcZFEUTsx6FVKqGGtoqx77srcJW1qBlV7cgSwuVAiwq1SYFc6krrYvG2gZtJVHr_IJdrn3Te83e02T9i3GWzMP11hw1oYXIhRQHlbx69YJ3IXjs3wApzDECszNrBOYYgVkjSNiXFdsv7YTdG_R358nwbTVg-uiB0JsAhHNaNHmEaDpH_5_wBx-EnWo</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Immune checkpoint inhibitor-induced myositis, the earliest and most lethal complication among rheumatic and musculoskeletal toxicities</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Allenbach, Yves ; Anquetil, Céline ; Manouchehri, Ali ; Benveniste, Olivier ; Lambotte, Olivier ; Lebrun-Vignes, Bénédicte ; Spano, Jean-Philippe ; Ederhy, Stéphane ; Klatzmann, David ; Rosenzwajg, Michelle ; Fautrel, Bruno ; Cadranel, Jacques ; Johnson, Douglas B. ; Moslehi, Javid J. ; Salem, Joe-Elie</creator><creatorcontrib>Allenbach, Yves ; Anquetil, Céline ; Manouchehri, Ali ; Benveniste, Olivier ; Lambotte, Olivier ; Lebrun-Vignes, Bénédicte ; Spano, Jean-Philippe ; Ederhy, Stéphane ; Klatzmann, David ; Rosenzwajg, Michelle ; Fautrel, Bruno ; Cadranel, Jacques ; Johnson, Douglas B. ; Moslehi, Javid J. ; Salem, Joe-Elie</creatorcontrib><description>In addition to restoring anti-tumor immune responses, immune checkpoint inhibitors (ICI) may also induce immune-related adverse events (irAE) that can affect any organ. We aim to determine the spectrum, timing, clinical features, and fatalities of rheumatic and musculoskeletal immune-related adverse events (RMS-irAE) associated with ICI.
We performed an observational, retrospective, pharmacovigilance study using the World Health Organization international pharmacovigilance database, VigiBase, from inception to January 2019. RMS-irAE reporting rate on ICI versus full database was performed using disproportionality analysis with computation of reporting-odds-ratios (ROR) and a Bayesian disproportional estimate (information component, IC). IC025 (lower end of the IC 95% credibility interval) >0 is deemed significant.
We identified 1288 RMS-irAE significantly associated with ICI: polymyalgia rheumatica (n = 76, ROR = 14.6 [11.6–18.4], IC025 = 3.34), sarcoidosis (n = 94; ROR = 9.6 [7.9–11.9]; IC025 = 2.85), Sjogren's syndrome (n = 49; ROR = 6.9 [5.2–9.2]; IC025 = 2.24), myositis (n = 465; ROR = 4.9 [4.5–5.4]; IC025 = 2.12), arthritis (n = 606; ROR = 1.4 [1.3–1.5]; IC025 = 0.34) and scleroderma (n = 17; ROR = 2.0 [1.2–3.2]; IC025 = 0.17). Arthritis, myositis, and Sjogren's syndrome were over-reported in patients treated with ICI combination versus those treated with ICI monotherapy (ROR = 1.6–2.9, p < .05) and more frequently reported on anti-PD1/PDL1 monotherapy vs. anti-CTLA4 monotherapy (2.1–4.4, p < .05). Median time to onset occurred early for myositis (31 days [19.2–57.8]) and was the most delayed for scleroderma (395 days [323.8–457.2], p < .0001). The fatality rate for RMS-irAE ranged from 24% for myositis (n = 106/441) (up to 56.7% with concurrent myocarditis) to [0–6.7%] for other RMS-irAE (p < .0001).
Clinicians should be aware of the spectrum of RMS-irAE. Myositis can be particularly life-threatening, particularly when associated with myocarditis.
•We identified over 1000 individual case safety reports related to RMS-irAE induced by ICI.•RMS-irAE encompassed arthritis, myositis, sarcoidosis, polymyalgia rheumatica, Sjogren's syndrome, and scleroderma.•Myositis occurred early within weeks after initiation of ICI therapy and carried a high fatality rate, particularly when concurrent myocarditis was reported; whereas other RMS-irAE had a low mortality burden.</description><identifier>ISSN: 1568-9972</identifier><identifier>EISSN: 1568-9972</identifier><identifier>EISSN: 1873-0183</identifier><identifier>DOI: 10.1016/j.autrev.2020.102586</identifier><identifier>PMID: 32535094</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adverse drug reactions ; Antineoplastic Agents, Immunological - adverse effects ; Bayes Theorem ; Humans ; Immune checkpoint inhibitors ; Life Sciences ; Myocarditis ; Myositis ; Myositis - chemically induced ; Myositis - mortality ; Myositis - pathology ; Pharmacology ; Pharmacovigilance ; Retrospective Studies ; Rheumatology</subject><ispartof>Autoimmunity reviews, 2020-08, Vol.19 (8), p.102586, Article 102586</ispartof><rights>2020 Elsevier B.V.</rights><rights>Copyright © 2020 Elsevier B.V. All rights reserved.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c559t-fe01228c8cb73ef6fa2eb18c41d8bc16ac72ce572b41de31474459aa9ea71e443</citedby><cites>FETCH-LOGICAL-c559t-fe01228c8cb73ef6fa2eb18c41d8bc16ac72ce572b41de31474459aa9ea71e443</cites><orcidid>0000-0002-0054-3422 ; 0000-0002-3185-7993 ; 0000-0002-1167-5797 ; 0000-0002-0331-3307</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1568997220301506$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32535094$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04003010$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Allenbach, Yves</creatorcontrib><creatorcontrib>Anquetil, Céline</creatorcontrib><creatorcontrib>Manouchehri, Ali</creatorcontrib><creatorcontrib>Benveniste, Olivier</creatorcontrib><creatorcontrib>Lambotte, Olivier</creatorcontrib><creatorcontrib>Lebrun-Vignes, Bénédicte</creatorcontrib><creatorcontrib>Spano, Jean-Philippe</creatorcontrib><creatorcontrib>Ederhy, Stéphane</creatorcontrib><creatorcontrib>Klatzmann, David</creatorcontrib><creatorcontrib>Rosenzwajg, Michelle</creatorcontrib><creatorcontrib>Fautrel, Bruno</creatorcontrib><creatorcontrib>Cadranel, Jacques</creatorcontrib><creatorcontrib>Johnson, Douglas B.</creatorcontrib><creatorcontrib>Moslehi, Javid J.</creatorcontrib><creatorcontrib>Salem, Joe-Elie</creatorcontrib><title>Immune checkpoint inhibitor-induced myositis, the earliest and most lethal complication among rheumatic and musculoskeletal toxicities</title><title>Autoimmunity reviews</title><addtitle>Autoimmun Rev</addtitle><description>In addition to restoring anti-tumor immune responses, immune checkpoint inhibitors (ICI) may also induce immune-related adverse events (irAE) that can affect any organ. We aim to determine the spectrum, timing, clinical features, and fatalities of rheumatic and musculoskeletal immune-related adverse events (RMS-irAE) associated with ICI.
We performed an observational, retrospective, pharmacovigilance study using the World Health Organization international pharmacovigilance database, VigiBase, from inception to January 2019. RMS-irAE reporting rate on ICI versus full database was performed using disproportionality analysis with computation of reporting-odds-ratios (ROR) and a Bayesian disproportional estimate (information component, IC). IC025 (lower end of the IC 95% credibility interval) >0 is deemed significant.
We identified 1288 RMS-irAE significantly associated with ICI: polymyalgia rheumatica (n = 76, ROR = 14.6 [11.6–18.4], IC025 = 3.34), sarcoidosis (n = 94; ROR = 9.6 [7.9–11.9]; IC025 = 2.85), Sjogren's syndrome (n = 49; ROR = 6.9 [5.2–9.2]; IC025 = 2.24), myositis (n = 465; ROR = 4.9 [4.5–5.4]; IC025 = 2.12), arthritis (n = 606; ROR = 1.4 [1.3–1.5]; IC025 = 0.34) and scleroderma (n = 17; ROR = 2.0 [1.2–3.2]; IC025 = 0.17). Arthritis, myositis, and Sjogren's syndrome were over-reported in patients treated with ICI combination versus those treated with ICI monotherapy (ROR = 1.6–2.9, p < .05) and more frequently reported on anti-PD1/PDL1 monotherapy vs. anti-CTLA4 monotherapy (2.1–4.4, p < .05). Median time to onset occurred early for myositis (31 days [19.2–57.8]) and was the most delayed for scleroderma (395 days [323.8–457.2], p < .0001). The fatality rate for RMS-irAE ranged from 24% for myositis (n = 106/441) (up to 56.7% with concurrent myocarditis) to [0–6.7%] for other RMS-irAE (p < .0001).
Clinicians should be aware of the spectrum of RMS-irAE. Myositis can be particularly life-threatening, particularly when associated with myocarditis.
•We identified over 1000 individual case safety reports related to RMS-irAE induced by ICI.•RMS-irAE encompassed arthritis, myositis, sarcoidosis, polymyalgia rheumatica, Sjogren's syndrome, and scleroderma.•Myositis occurred early within weeks after initiation of ICI therapy and carried a high fatality rate, particularly when concurrent myocarditis was reported; whereas other RMS-irAE had a low mortality burden.</description><subject>Adverse drug reactions</subject><subject>Antineoplastic Agents, Immunological - adverse effects</subject><subject>Bayes Theorem</subject><subject>Humans</subject><subject>Immune checkpoint inhibitors</subject><subject>Life Sciences</subject><subject>Myocarditis</subject><subject>Myositis</subject><subject>Myositis - chemically induced</subject><subject>Myositis - mortality</subject><subject>Myositis - pathology</subject><subject>Pharmacology</subject><subject>Pharmacovigilance</subject><subject>Retrospective Studies</subject><subject>Rheumatology</subject><issn>1568-9972</issn><issn>1568-9972</issn><issn>1873-0183</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctq3TAQhkVJaS7tG5SibSA-lWT5timEkBsc6KZdC3k8rufEtg6SfEheoM9dHZyGrrrS8Ov_ZqT5GfssxUYKWX7dbewSPR42SqijpIq6fMfOZFHWWdNU6uSf-pSdh7ATCWtU84Gd5qrIC9HoM_b7cZqWGTkMCE97R3PkNA_UUnQ-o7lbADs-vbhAkcIVjwNytH4kDJHbOV25VIwYBztycNN-JLCR3Mzt5OZf3A-4TEmA1bwEWEYXnjARCYjumSA1xvCRve_tGPDT63nBft7d_rh5yLbf7x9vrrcZFEUTsx6FVKqGGtoqx77srcJW1qBlV7cgSwuVAiwq1SYFc6krrYvG2gZtJVHr_IJdrn3Te83e02T9i3GWzMP11hw1oYXIhRQHlbx69YJ3IXjs3wApzDECszNrBOYYgVkjSNiXFdsv7YTdG_R358nwbTVg-uiB0JsAhHNaNHmEaDpH_5_wBx-EnWo</recordid><startdate>202008</startdate><enddate>202008</enddate><creator>Allenbach, Yves</creator><creator>Anquetil, Céline</creator><creator>Manouchehri, Ali</creator><creator>Benveniste, Olivier</creator><creator>Lambotte, Olivier</creator><creator>Lebrun-Vignes, Bénédicte</creator><creator>Spano, Jean-Philippe</creator><creator>Ederhy, Stéphane</creator><creator>Klatzmann, David</creator><creator>Rosenzwajg, Michelle</creator><creator>Fautrel, Bruno</creator><creator>Cadranel, Jacques</creator><creator>Johnson, Douglas B.</creator><creator>Moslehi, Javid J.</creator><creator>Salem, Joe-Elie</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>1XC</scope><scope>VOOES</scope><orcidid>https://orcid.org/0000-0002-0054-3422</orcidid><orcidid>https://orcid.org/0000-0002-3185-7993</orcidid><orcidid>https://orcid.org/0000-0002-1167-5797</orcidid><orcidid>https://orcid.org/0000-0002-0331-3307</orcidid></search><sort><creationdate>202008</creationdate><title>Immune checkpoint inhibitor-induced myositis, the earliest and most lethal complication among rheumatic and musculoskeletal toxicities</title><author>Allenbach, Yves ; Anquetil, Céline ; Manouchehri, Ali ; Benveniste, Olivier ; Lambotte, Olivier ; Lebrun-Vignes, Bénédicte ; Spano, Jean-Philippe ; Ederhy, Stéphane ; Klatzmann, David ; Rosenzwajg, Michelle ; Fautrel, Bruno ; Cadranel, Jacques ; Johnson, Douglas B. ; Moslehi, Javid J. ; Salem, Joe-Elie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c559t-fe01228c8cb73ef6fa2eb18c41d8bc16ac72ce572b41de31474459aa9ea71e443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adverse drug reactions</topic><topic>Antineoplastic Agents, Immunological - adverse effects</topic><topic>Bayes Theorem</topic><topic>Humans</topic><topic>Immune checkpoint inhibitors</topic><topic>Life Sciences</topic><topic>Myocarditis</topic><topic>Myositis</topic><topic>Myositis - chemically induced</topic><topic>Myositis - mortality</topic><topic>Myositis - pathology</topic><topic>Pharmacology</topic><topic>Pharmacovigilance</topic><topic>Retrospective Studies</topic><topic>Rheumatology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Allenbach, Yves</creatorcontrib><creatorcontrib>Anquetil, Céline</creatorcontrib><creatorcontrib>Manouchehri, Ali</creatorcontrib><creatorcontrib>Benveniste, Olivier</creatorcontrib><creatorcontrib>Lambotte, Olivier</creatorcontrib><creatorcontrib>Lebrun-Vignes, Bénédicte</creatorcontrib><creatorcontrib>Spano, Jean-Philippe</creatorcontrib><creatorcontrib>Ederhy, Stéphane</creatorcontrib><creatorcontrib>Klatzmann, David</creatorcontrib><creatorcontrib>Rosenzwajg, Michelle</creatorcontrib><creatorcontrib>Fautrel, Bruno</creatorcontrib><creatorcontrib>Cadranel, Jacques</creatorcontrib><creatorcontrib>Johnson, Douglas B.</creatorcontrib><creatorcontrib>Moslehi, Javid J.</creatorcontrib><creatorcontrib>Salem, Joe-Elie</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><jtitle>Autoimmunity reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Allenbach, Yves</au><au>Anquetil, Céline</au><au>Manouchehri, Ali</au><au>Benveniste, Olivier</au><au>Lambotte, Olivier</au><au>Lebrun-Vignes, Bénédicte</au><au>Spano, Jean-Philippe</au><au>Ederhy, Stéphane</au><au>Klatzmann, David</au><au>Rosenzwajg, Michelle</au><au>Fautrel, Bruno</au><au>Cadranel, Jacques</au><au>Johnson, Douglas B.</au><au>Moslehi, Javid J.</au><au>Salem, Joe-Elie</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Immune checkpoint inhibitor-induced myositis, the earliest and most lethal complication among rheumatic and musculoskeletal toxicities</atitle><jtitle>Autoimmunity reviews</jtitle><addtitle>Autoimmun Rev</addtitle><date>2020-08</date><risdate>2020</risdate><volume>19</volume><issue>8</issue><spage>102586</spage><pages>102586-</pages><artnum>102586</artnum><issn>1568-9972</issn><eissn>1568-9972</eissn><eissn>1873-0183</eissn><abstract>In addition to restoring anti-tumor immune responses, immune checkpoint inhibitors (ICI) may also induce immune-related adverse events (irAE) that can affect any organ. We aim to determine the spectrum, timing, clinical features, and fatalities of rheumatic and musculoskeletal immune-related adverse events (RMS-irAE) associated with ICI.
We performed an observational, retrospective, pharmacovigilance study using the World Health Organization international pharmacovigilance database, VigiBase, from inception to January 2019. RMS-irAE reporting rate on ICI versus full database was performed using disproportionality analysis with computation of reporting-odds-ratios (ROR) and a Bayesian disproportional estimate (information component, IC). IC025 (lower end of the IC 95% credibility interval) >0 is deemed significant.
We identified 1288 RMS-irAE significantly associated with ICI: polymyalgia rheumatica (n = 76, ROR = 14.6 [11.6–18.4], IC025 = 3.34), sarcoidosis (n = 94; ROR = 9.6 [7.9–11.9]; IC025 = 2.85), Sjogren's syndrome (n = 49; ROR = 6.9 [5.2–9.2]; IC025 = 2.24), myositis (n = 465; ROR = 4.9 [4.5–5.4]; IC025 = 2.12), arthritis (n = 606; ROR = 1.4 [1.3–1.5]; IC025 = 0.34) and scleroderma (n = 17; ROR = 2.0 [1.2–3.2]; IC025 = 0.17). Arthritis, myositis, and Sjogren's syndrome were over-reported in patients treated with ICI combination versus those treated with ICI monotherapy (ROR = 1.6–2.9, p < .05) and more frequently reported on anti-PD1/PDL1 monotherapy vs. anti-CTLA4 monotherapy (2.1–4.4, p < .05). Median time to onset occurred early for myositis (31 days [19.2–57.8]) and was the most delayed for scleroderma (395 days [323.8–457.2], p < .0001). The fatality rate for RMS-irAE ranged from 24% for myositis (n = 106/441) (up to 56.7% with concurrent myocarditis) to [0–6.7%] for other RMS-irAE (p < .0001).
Clinicians should be aware of the spectrum of RMS-irAE. Myositis can be particularly life-threatening, particularly when associated with myocarditis.
•We identified over 1000 individual case safety reports related to RMS-irAE induced by ICI.•RMS-irAE encompassed arthritis, myositis, sarcoidosis, polymyalgia rheumatica, Sjogren's syndrome, and scleroderma.•Myositis occurred early within weeks after initiation of ICI therapy and carried a high fatality rate, particularly when concurrent myocarditis was reported; whereas other RMS-irAE had a low mortality burden.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>32535094</pmid><doi>10.1016/j.autrev.2020.102586</doi><orcidid>https://orcid.org/0000-0002-0054-3422</orcidid><orcidid>https://orcid.org/0000-0002-3185-7993</orcidid><orcidid>https://orcid.org/0000-0002-1167-5797</orcidid><orcidid>https://orcid.org/0000-0002-0331-3307</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adverse drug reactions Antineoplastic Agents, Immunological - adverse effects Bayes Theorem Humans Immune checkpoint inhibitors Life Sciences Myocarditis Myositis Myositis - chemically induced Myositis - mortality Myositis - pathology Pharmacology Pharmacovigilance Retrospective Studies Rheumatology |
| title | Immune checkpoint inhibitor-induced myositis, the earliest and most lethal complication among rheumatic and musculoskeletal toxicities |
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