COVID-19 pandemic year in a sample of Polish myasthenia gravis patients: an observational study

Abstract

Aim of the study: Coronavirus disease 2019 (COVID-19) incidence, mortality, recovery and hospitalisation rates vary in different countries. This study aimed to present the clinical characteristics of a sample of unvaccinated Polish myasthenia gravis (MG) patients during the first year of the COVID-19 pandemic, taking into account the number of MG exacerbations, a detailed description of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection course, and the need to modify immunosuppressive therapies. Clinical rationale for the study:To assess the impact of the first COVID-19 pandemic year on MG course in a sample of unvaccinated patients. Materials and methods: A retrospective observational study involving 30 unvaccinated Polish MG patients consulted in a neurological outpatient clinic on 11-31 March, 2020 (baseline) and 11-31 March, 2021 (endpoint).Results: During the period of evaluation, exacerbation of MG requiring hospitalisation was reported in 11 patients. Among them, four were treated with intravenous immunoglobulin and another six required plasma exchange. In the study group, COVID-19 was identified in 10 patients. Of them, seven experienced a mild course of SARSCoV-2 infection with spontaneous recovery. In the remaining three patients, both MG exacerbation and SARS-CoV-2 infection were reported. These patients experienced MG exacerbation in the preceding month or concurrently with COVID-19 and were aged over 50 years. Due to the SARS-CoV-2 infection, they required antibiotic and oxygen therapy, and hospitalisation was necessary in the case of two obese patients. None of the patients died due to COVID-19, and nor did any require discontinuation of immunosuppressive therapies during the study period. In total, 12 patients in the study group experienced neither MG exacerbation nor SARS-CoV-2 infection. Conclusions:In the presented sample of Polish MG patients, favourable outcomes of COVID-19 were observed. Further studies are needed to evaluate the reliable course of COVID-19 taking into account international differences, the types of treatment applied, and the ratio of vaccinated to unvaccinated MG patients.

Impact of COVID-19 in AChR Myasthenia Gravis and the Safety of Vaccines: Data from an Italian Cohort

“…The burden of COVID-19 in MG patients over the last two years has been the object of a few case series and retrospective studies [ 4 , 33 , 34 ], demonstrating a clinical deterioration of MG patients and going as far as admission to the ICU in more severe cases [ 11 , 35 , 36 , 37 , 38 ]. These studies reported up to 30% lethality [ 4 , 33 , 36 , 37 , 39 ] and a high rate of complications [ 33 , 34 , 36 , 37 , 38 ].…”

“…The burden of COVID-19 in MG patients over the last two years has been the object of a few case series and retrospective studies [ 4 , 33 , 34 ], demonstrating a clinical deterioration of MG patients and going as far as admission to the ICU in more severe cases [ 11 , 35 , 36 , 37 , 38 ]. These studies reported up to 30% lethality [ 4 , 33 , 36 , 37 , 39 ] and a high rate of complications [ 33 , 34 , 36 , 37 , 38 ]. The prevalence of COVID-19 is broadly variable between population studies, from between 0.96 to 30%, with data heterogeneity reflecting several factors—including diffusion of SARS-CoV2, the period of study, and vaccination policies [ 40 ].…”

To Be or Not To Be Vaccinated: That Is a Question in Myasthenia Gravis

“…These figures are valuable because of analyzing a number of patients, but they did not consider international variations in the infection course. Unexpectedly, studies in the French and Polish cohorts showed COVID-19 had limited effect on most MG patients, while high myasthenia gravis foundation of America (MGFA) class (≥IV) before COVID-19 was associated with severe COVID-19 (117,120). IST did not have a significant impact on infection risk (120,121).…”

“…IST did not have a significant impact on infection risk (120,121). Another important aspect influencing the infection course in MG patients is international differences in the number of vaccinated populations as those who get vaccinated will form a "cocoon effect" to protect those who cannot be vaccinated (117).…”

“…Today, MG patients with COVID-19 infections experience a highly variable course and outcome. The percentage of patients who need hospitalization and/or experienced MG exacerbation varies across studies (117). MG patients might face a higher risk of severe outcome, especially those with respiratory muscle weakness, older age, other and other medical or neurologic diseases (118).…”