Clinical course and outcome of an outpatient clinic population with myasthenia gravis and <scp>COVID</scp>‐19

Tuncer, Özlem; Deymeer, Feza

doi:10.1002/mus.27497

Cited by 13 publications

(10 citation statements)

References 30 publications

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“…A more severe form of COVID-19 (hospitalization required) was recorded in approximately one third of our SARS-CoV-2 infected MG patients. These results coincide with data obtained in the Turkish study [ 19 ], but not with the results from the French cohort study where this percentage was nearly twice as high [ 20 ]. The explanation for this dissimilarity may be the fact that 60% of patients in the French study had a severe form of MG at the time of COVID-19 infection, while most of our patients had a mild form of MG.…”

Section: Discussionsupporting

confidence: 86%

“…Moreover, these data are in accordance with a Polish study where 33.3% of MG patients had COVID-19 [ 18 ]. On the other hand, previous studies from Turkey and France reported significantly lower prevalence of COVID-19 infection (0.96% and 13.5%, respectively) among patients with MG [ 19 , 20 ]. The basic cause of these differences might be the disparity between the study conducting time and the course of the pandemic, as well as different prevalence among general population in these countries.…”

Section: Discussionmentioning

confidence: 76%

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COVID-19 infection and vaccination against SARS-CoV-2 in myasthenia gravis

et al. 2022

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Introduction Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction which is typically presented with muscle weakness and excessive fatigability. Majority of MG patients require long-term immune suppression. Our aim was to analyze the frequency and severity of COVID-19 infection in MG patients, as well as the frequency of vaccinated MG patients against SARS-CoV-2. Methods We included 125 MG patients from the central Belgrade municipalities—60% females, age at MG onset 50.1 ± 19.7 years, age at testing 61.7 ± 16.8 years, anti-acetylcholine receptor (anti-AChR) positive 78% and muscle specific tyrosine kinase (MuSK) positive 8.6%. Results One-third of our MG patients had a COVID-19 infection and they were younger compared to those without verified COVID-19. Severe COVID-19 infection was registered in 28% of MG patients, mostly in elder subjects with comorbidities such as cardiac diseases and malignancies. MG worsening was noted in 21% of patients during/after COVID-19 and 42% had COVID-19 sequelae. Majority of MG patients were vaccinated against SARS-CoV-2 (almost 70%). Vaccination was more common among MG patients with diabetes and in those with a milder form of MG. The most common types of vaccines were Sinopharm (42%) and Pfizer-BioNTech (25.6%). Adverse events were observed in 36% of vaccinated patients, with flu-like symptoms (77%) and local reactions (13%) being the most common ones. MG worsening was noticed in 5 (5.8%) patients after vaccination. Conclusion COVID-19 has placed a significant new burden for MG patients. Elder MG patients and patients with comorbidities are in higher risk of having adverse outcome following SARS-CoV-2 infection. Percentage of vaccinated MG patients was higher than in general Serbian population.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 76%

COVID-19 infection and vaccination against SARS-CoV-2 in myasthenia gravis

et al. 2022

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“…On the other hand, MG may be triggered or worsened by infections in general [ 24 ]. Small-scale studies have been conducted regarding COVID-19 specifically, showing increased exacerbation rate, need for increased dosage, and prolonged hospital stay following infection [ 25 , 26 ]. A case report has shown a myasthenic crisis as a complication of COVID-19 [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

BNT162b2 mRNA COVID-19 vaccine three-dose safety and risk of COVID-19 in patients with myasthenia gravis during the alpha, delta, and omicron waves

et al. 2022

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COVID-19 affects the respiratory parenchyma and may potentially contribute to the tendency of myasthenia gravis (MG) patients to develop respiratory failure. It is, therefore, important to study the safety of vaccines against SARS-CoV-2 and to assess the risk of COVID-19 in MG patients. The safety of the three-dose BNT162b2 mRNA vaccine and outcomes of COVID-19 during the alpha, delta, and omicron waves were studied in MG patients as well as the rate of exacerbations and safety for a period of up to 6 weeks from each vaccine dose and patient morbidity and mortality during COVID-19 compared to the general population. 430 vaccine doses were administered across 150 patients. Thirteen patients (8.7%) complained of exacerbation within 6 weeks of each vaccine dose. Both MG onset rate and exacerbation rate were similar to previous years. MG exacerbation rate among fifteen patients who had COVID-19 was significantly higher (40%) compared to the rate following vaccination. During the alpha and delta waves, COVID-19 mortality and severe disease were significantly higher (26.7%) compared to the general population (0.96%). All of them were unvaccinated and had generalized MG. During the omicron wave, all the MG patients who contracted COVID-19 were vaccinated and had mild disease. We concluded that COVID-19 is hazardous for generalized MG patients, while the vaccination did not raise the risk for either exacerbation or new onset of MG and was associated with a reduced risk for severe COVID-19. Hence, it is recommended for generalized MG patients to get vaccinated. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11303-8.

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“…Exacerbation of MG due to COVID-19 has been reported in new-onset pediatric cases 4 and adult cases. 2 5 6 7 8 9 However, to the best of our knowledge, the effect of COVID-19 in children with MG remains unclear.…”

Section: Discussionmentioning

confidence: 99%

A Case of Generalized Myasthenia Gravis Exacerbated by COVID-19

Kanatani

Yamaguchi

Oikawa

et al. 2023

Journal of Pediatric Neurology

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Myasthenia gravis (MG) is a rare, long-term neuromuscular disorder that can affect individuals of any age. In Japan, the Omicron variant of coronavirus disease 2019 (COVID-19) began spreading in 2022, and many cases of neurological symptoms caused by the virus have been reported. Although COVID-19 has been reported to exacerbate MG in adults, there are no reports on the effects of COVID-19 on the MG symptoms of pediatric patients. We report the case of a 6-year-old girl with a 3-year history of MG who presented to our hospital with symptom exacerbation after COVID-19 infection. Four days before admission, she developed fever with a runny nose and cough. Three days before admission, she developed severe bilateral blepharoptosis and progressive limb weakness, and 2 days before admission, she was diagnosed with COVID-19 by SARS-CoV-2 antigen test. Physical examination revealed moderate blepharoptosis and mild bilateral upper and lower limb weakness. We diagnosed her with worsening MG due to COVID-19, and she was administered 400 mg/kg intravenous immunoglobulin (IVIG) daily for 5 days with continued oral corticosteroids and tacrolimus. The patient's symptoms improved promptly after admission and, at discharge 7 days after admission, her symptoms had significantly improved. During the 1-month outpatient follow-up period, she remained stable and the anti-acetylcholine receptor (AchR) antibody level was reduced to 14.6 nmol/L (from 18.5 nmol/L on admission). Our case suggests that COVID-19 exacerbates MG in both children and adults.

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Clinical course and outcome of an outpatient clinic population with myasthenia gravis and COVID‐19

Cited by 13 publications

References 30 publications

COVID-19 infection and vaccination against SARS-CoV-2 in myasthenia gravis

COVID-19 infection and vaccination against SARS-CoV-2 in myasthenia gravis

BNT162b2 mRNA COVID-19 vaccine three-dose safety and risk of COVID-19 in patients with myasthenia gravis during the alpha, delta, and omicron waves

A Case of Generalized Myasthenia Gravis Exacerbated by COVID-19

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