COVID‐19 in patients with myasthenia gravis: Epidemiology and disease course

Abstract

Introduction/Aims Coronavirus disease 2019 (COVID‐19), a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, has become a global pandemic. Patients with myasthenia gravis (MG), often treated with immunosuppressants, might be at higher risk of developing COVID‐19 and of demonstrating a severe disease course. We aimed to study prevalence and describe features of COVID‐19 in MG patients. Methods In May 2020, we conducted telephonic interviews with MG patients followed at our referral center. We collected structured data regarding MG and COVID‐19, which was diagnosed as probable or confirmed according to the European Centre for Disease Prevention and Control case definition. We compared confirmed‐COVID‐19 prevalence calculated from the beginning of the pandemic in MG patients with that of the overall Pavia district. Results We interviewed 162 MG patients (median age, 66 y; interquartile range 41‐77; males 59.9%), 88 from the Pavia district. Three patients had SARS‐CoV‐2‐confirmed by polymerase chain reaction and eight had probable‐COVID‐19. In the Pavia district, the prevalence of confirmed‐COVID‐19 among MG patients (1/88, 1.14%) and overall population (4777/546 515, 0.87%) did not differ ( P = .538). Higher Myasthenia Gravis Foundation of America clinicalclass and the need for recent rescue treatment, but not ongoing immunosuppressive treatments, were associated with COVID‐19 risk. Of 11 MG patients with probable/confirmed‐COVID‐19, 3 required ventilator support, and 2 elderly patients died of COVID‐19 respiratory insufficiency. Only 1 of11 patients experienced worsening MG symptoms, which improved after increasing their steroid dose. Discussion The risk of COVID‐19 in MG patients seems to be no higher than that of the general population, regardless of immunosuppressive therapies. In our cohort, COVID‐19 barely affected MG course.

Characteristics, treatment, and outcomes of Myasthenia Gravis in COVID-19 patients: A systematic review

“…After examining the titles and abstracts of the remaining articles, 19 studies with 152 patients with confirmed MG diagnosis and COVID-19 were included in the qualitative systematic review ( Fig. 1 ) [3] , [6] , [8] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] . Of these studies, 10 were case series, 8 were case reports, and one was a cohort study, as shown in Supplementary Tables 1 and 4 .…”

“…Previous long-term treatment particularly in higher dose was reported to be among the most important predictors of severe COVID-19 in MG patients [29] . However, some reports have suggested that suppression of the immune response may be protective against infection since immunosuppression can decrease the dramatic upregulation of inflammatory cytokines that can cause complications [56] , [57] , while others suggested that the risk of COVID-19 in MG patients does not appear to be higher than that of the general population, regardless of immunosuppressive therapies [28] . We found that in our study, patients treated with prednisone/corticosteroids before the diagnosis of COVID-19 or during COVID-19 had a high rate of mortality when used alone.…”

Patients With Myasthenia Gravis With Acute Onset of Dyspnea: Predictors of Progression to Myasthenic Crisis and Prognosis

“…However, the current evidence on the relationship between MG and COVID-19 is highly variable. Some studies suggested that COVID-19 has a limited effect on most of the patients with MG, since most of the patients in these studies do not experience exacerbations of MG, and immunosuppressive therapy is relatively safe (23)(24)(25). In contrast, other studies found a high proportion of patients with MG exacerbations requiring rescue therapy or mechanical ventilation (26,27).…”

Myasthenia Gravis Exacerbation and Myasthenic Crisis Associated With COVID19: Case Series and Literature Review.

“…Viral and bacterial respiratory infections are common triggers for exacerbation in MG. COVID19 has also been described as a trigger for exacerbation [3,[7][8][9], although MG worsening appears to be uncommon in COVID, affecting only 10-15% of patients [4,5]. Comparing this number to seasonal in uenza, a recent study performed before the coronavirus pandemic has shown that an in uenza-like illness (de ned as fever of ≥38℃ accompanied by cough and/or sore throat) resulted in exacerbation in 40% of myasthenic patients [10].…”

“…Exacerbation of MG during COVID19 infection appears to be uncommon, ranging from 10-15% [4,5]. The scenario of myasthenia exacerbation due to COVID19 can be challenging, both due to diagnostic concerns (is respiratory insu ciency related to hypoventilation secondary to muscle weakness or hypoxia secondary to pulmonary involvement?)…”