Clinical spectrum of neuromuscular complications after immune checkpoint inhibition

•Neuromuscular complications are most common in first three months.•Muscle complications and high serum CK are common with new onset of weakness.•There is a high prevalence of myasthenia overlap with myositis and/or myocarditis.•Pre-existing myasthenia gravis is associated with high morbidity.•Diplopia may be caused either by myasthenia gravis or orbital myositis. Cancer immunotherapy has transformed the field of oncology and enabled more effective management of previously refractory neoplasms by activation of the immune response. Upregulation of the immune response may also trigger autoimmune adverse events, including neuromuscular complications. We performed a systematic review of autoimmune neuromuscular complications following immune checkpoint blockade. We searched PubMed database and identified 81 cases described, including 30 cases of myasthenia gravis (MG), 29 cases of neuropathy and 22 cases of myopathy. Most patients (89%) developed neuromuscular complications within 3 months from starting immune checkpoint blockade and 40% of all patients had elevated serum CK>1000 IU/L (typical normal