Flare of myasthenia gravis induced by COVID-19 vaccines

Ishizuchi, Kei; Takizawa, Tsubasa; Sekiguchi, Koji; Motegi, Haruhiko; Oyama, Munenori; Nakahara, Jin; Suzuki, Shigeaki

doi:10.1016/j.jns.2022.120225

Cited by 25 publications

(31 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 63 While COVID-19 vaccination appears to be safe in MG, due to the possibility of potential flare-up of existing MG, it is reasonable to postpone vaccination in patients with myasthenic crisis and severe bulbar symptoms. 64 Future prospective trials are required to confirm these observations.…”

Section: Covid 19 Vaccination In Mg Patientsmentioning

confidence: 99%

Practical Management for Use of Eculizumab in the Treatment of Severe, Refractory, Non-Thymomatous, AChR + Generalized Myasthenia Gravis: A Systematic Review

Waheed¹,

Newman²,

Aboukhatwa³

et al. 2022

TCRM

View full text Add to dashboard Cite

Myasthenia gravis (MG) is a rare autoimmune disorder caused by specific autoantibodies at the neuromuscular junction. MG is classified by the antigen specificity of these antibodies. Acetylcholine receptor (AChR) antibodies are the most common type (74–88%), followed by anti-muscle specific kinase (MuSK) and other antibodies. While all these antibodies lead to neuromuscular transmission failure, the immuno-pathogenic mechanisms are distinct. Complement activation is a primary driver of AChR antibody-positive MG (AChR+ MG) pathogenesis. This leads to the formation of the membrane attack complex and destruction of AChR receptors and the postsynaptic membrane resulting in impaired neurotransmission and muscle weakness characteristic of MG. Broad-based immune-suppressants like corticosteroids are effective in controlling MG; however, their long-term use can be associated with significant adverse effects. Advances in translational research have led to the development of more directed therapeutic agents that are likely to alter the future of MG treatment. Eculizumab is a humanized monoclonal antibody that inhibits the cleavage of complement protein C5 and is approved for use in generalized MG. In this review, we discuss the pathophysiology of MG; the therapeutic efficacy and tolerability of eculizumab, as well as the practical guidelines for its use in MG; future studies exploring the role of eculizumab in different stages and subtypes of MG subtypes; the optimal duration of therapy and its discontinuation; the characterization of non-responder patients; and the use of biomarkers for monitoring therapy are highlighted. Based on the pathophysiologic mechanisms, emerging therapies and new therapeutic targets are also reviewed.

show abstract

Section: Covid 19 Vaccination In Mg Patientsmentioning

confidence: 99%

Practical Management for Use of Eculizumab in the Treatment of Severe, Refractory, Non-Thymomatous, AChR + Generalized Myasthenia Gravis: A Systematic Review

Waheed¹,

Newman²,

Aboukhatwa³

et al. 2022

TCRM

View full text Add to dashboard Cite

show abstract

“…In a retrospective study on an Italian cohort of 80 patients, transient worsening after vaccination was noted in 5% of patients [11]. In a prospective study following 343 Japanese patients, transient worsening was observed in 1% of patients and the response to treatment was favourable [12]. Therefore, the authors concluded that vaccination should be recommended for patients diagnosed with…”

Section: Discussionmentioning

confidence: 98%

“…Studies of SARS-CoV-2 vaccination in patients with established diagnosis of MG suggest that it might rarely lead to disease worsening [11,12]. In a retrospective study on an Italian cohort of 80 patients, transient worsening after vaccination was noted in 5% of patients [11].…”

Section: Discussionmentioning

confidence: 98%

New-Onset Ocular Myasthenia Gravis After Booster Dose of COVID-19 Vaccine

Abičić¹,

Sitaš²,

Adamec³

et al. 2022

Cureus

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) vaccines have been reported as possible triggers of the production of antibodies pathogenic to the peripheral nerve and neuromuscular junction. We report on a patient who experienced vertical diplopia three weeks after the booster dose of the Pfizer-BioNTech vaccine (Comirnaty®). The diagnosis of myasthenia gravis (MG) was established based on highly positive antibodies to the nicotinic acetylcholine receptor (nAChR). Treatment with pyridostigmine and prednisone was started with gradually raising doses. On a follow-up exam two months after treatment initiation, clinical improvement was noted with an almost normal bulbomotor examination. The occurrence of diplopia following COVID-19 vaccination should raise suspicion of new-onset ocular MG and testing for anti-nAChR antibodies is advised.

show abstract

“…Furthermore, a recent case study reported that the BNT162b2 vaccine induced the development of acute transverse myelitis followed by fatal neurological complications [ 18 ]. A few cases have been reported for BNT162b2 vaccine-induced myasthenia gravis (MG) development, a chronic autoimmune condition affecting the neuromuscular junction [ 19 , 20 , 21 ]. However, some studies demonstrated that BNT162b2 vaccination showed overall good short-term safety in MG patients [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical and Molecular Characterization of a Rare Case of BNT162b2 mRNA COVID-19 Vaccine-Associated Myositis

et al. 2022

View full text Add to dashboard Cite

Initial clinical trials and surveillance data have shown that the most commonly administered BNT162b2 COVID-19 mRNA vaccine is effective and safe. However, several cases of mRNA vaccine-induced mild to moderate adverse events were recently reported. Here, we report a rare case of myositis after injection of the first dose of BNT162b2 COVID-19 mRNA vaccine into the left deltoid muscle of a 34-year-old, previously healthy woman who presented progressive proximal muscle weakness, progressive dysphagia, and dyspnea with respiratory failure. One month after vaccination, BNT162b2 vaccine mRNA expression was detected in a tissue biopsy of the right deltoid and quadriceps muscles. We propose this case as a rare example of COVID-19 mRNA vaccine-induced myositis. This study comprehensively characterizes the clinical and molecular features of BNT162b2 mRNA vaccine-associated myositis in which the patient was severely affected.

show abstract

Flare of myasthenia gravis induced by COVID-19 vaccines

Cited by 25 publications

References 6 publications

Practical Management for Use of Eculizumab in the Treatment of Severe, Refractory, Non-Thymomatous, AChR + Generalized Myasthenia Gravis: A Systematic Review

Practical Management for Use of Eculizumab in the Treatment of Severe, Refractory, Non-Thymomatous, AChR + Generalized Myasthenia Gravis: A Systematic Review

New-Onset Ocular Myasthenia Gravis After Booster Dose of COVID-19 Vaccine

Clinical and Molecular Characterization of a Rare Case of BNT162b2 mRNA COVID-19 Vaccine-Associated Myositis

Contact Info

Product

Resources

About