Immunogenicity of repeat COVID-19 mRNA vaccinations in a patient with myasthenia gravis receiving mycophenolate, prednisone, and eculizumab

Plymate, Lisa C.; Pepper, Gregory; Krist, Maxwell P.; Koelle, David M.

doi:10.1016/j.jtauto.2021.100114

Cited by 9 publications

(9 citation statements)

References 9 publications

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“…In the first one, a 74-year-old MG patient treated with mycophenolate, prednisone and eculizumab received both doses of the Pfizer BNT162b2, which failed to induce detectable specific circulating IgG or IFN-gamma T-cell responses. She was then administered both doses of Moderna M1273 vaccine, the aforementioned vaccine immunogenicity tests were repeated and resulted positive [ 48 ]. The second study regarded a 75-year-old MG patient under steroid and mycophenolate treatment, who received a complete cycle of the Moderna M1273 vaccine, resulting in the absence of detectable specific neutralising circulating antibodies, unlike immunocompetent individuals.…”

Section: Resultsmentioning

confidence: 99%

“…MG patients receiving prednisone and chronic plasmapheresis had higher pre-immunization titres than did other patient groups and had significantly higher postimmunization titres than other MG subgroups. Antibody rebound and overshoot phenomena after plasmapheresis is a possible explanation SARS-CoV2 (Pfizer mRNA BNT162b2 and Moderna mRNA 1273 vaccines) Plymate et al [ 48 ] 1 MG pts Case report Immunogenicity tests 71 days after end of 1 st cycle, 85 days after end of 2 nd cycle No detectable specific T- and B-cells vaccine immunogenicity tests after 1st cycle with BNT162b2; positive tests after 2nd cycle with M1273. Repeat vaccination might represent a strategy to increase vaccine efficacy SARS-CoV2 (Pfizer mRNA BNT162b2 and Moderna mRNA 1273 vaccines) Golding et al [ 49 ] 1 MG pts Case report Immunogenicity tests 4 weeks after end of 1 st cycle, 2 weeks after end of 2 nd cycle No detectable specific neutralising antibodies after 1st cycle with M1273; elevated titre after 2nd cycle with Pfizer BNT162b2 and temporary interruption of immunosuppressive therapy.…”

Section: Discussionmentioning

confidence: 99%

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Vaccines and myasthenia gravis: a comprehensive review and retrospective study of SARS-CoV-2 vaccination in a large cohort of myasthenic patients

Sansone

Bonifati

2022

J Neurol

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Introduction Myasthenia gravis (MG) is an autoimmune disease, for which the risk of exacerbation after vaccines is debated. The aim of this study is to review the available literature concerning safety and efficacy of vaccines in MG. In addition, we also conducted a retrospective research of MG exacerbations and new onset MG after anti-SARS-CoV-2 vaccination in a large cohort of patients. Methods A study of the available literature regarding vaccines and MG was carried out through research in the online database “Pubmed”. We also retrospectively collected data from 80 MG patients, who were followed at the Treviso Hospital and completed an anti-SARS-CoV-2 vaccination cycle. For each patient, we recorded MG exacerbations between first and second doses and within a window period of 1 day – 6 weeks after the second dose. Results We found 26 relevant articles about influenza, SARS-CoV-2 and other vaccines. No clear associations between most vaccines and MG exacerbations were found. Moreover, cases of new onset post-vaccine MG are mostly anecdotal, except for Japanese encephalitis virus vaccine. Concerning our cohort, 4/80 (5%) MG patients experienced an exacerbation within the post-vaccine window period. In addition, we report a case of new onset post-vaccine MG. Discussion Inactivated and subunit vaccines are safe and effective in MG. Although some of them, such as anti-SARS-CoV-2 vaccine, might uncommonly cause MG exacerbations, data from our review suggest that benefits still outweigh by far the potential risks, thus they should be recommended to these patients. Nevertheless, large prospective studies are needed for further investigations.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Vaccines and myasthenia gravis: a comprehensive review and retrospective study of SARS-CoV-2 vaccination in a large cohort of myasthenic patients

Sansone

Bonifati

2022

J Neurol

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“…There were three case reports that discussed about the possibility exacerbation of moderate symptoms of MG because of COVID-19 mRNA vaccine in geriatric patients, but these reports need further follow-up and research related that incidences were causal or coincidental [ 63 – 65 ]. While Plymate and colleagues (2021) reported the safety of mRNA COVID-19 vaccine in MG patients and the benefit of additional doses of vaccine [ 66 ]. The Guidance for the management of MG and LEMS during the COVID-19 pandemic by International MG/COVID-19 Working Group suggests the use of dead vaccine in this group [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

The relationship between myasthenia gravis and COVID-19: a systematic review

Tugasworo

Kurnianto

Retnaningsih

et al. 2022

Egypt J Neurol Psychiatry Neurosurg

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Introduction Viral infection such as coronavirus disease 2019 (COVID-19) can exacerbate and aggravate neurological disorders due to autoimmune etiology like myasthenia gravis (MG). Experimental therapies used in COVID-19 are also factors that can cause the worsening of MG symptoms. This review aimed to assess and conclude the research-based study systematically to analyze the relationship of MG and COVID-19. Method This study was conducted in accordance to Cochrane handbook for systematic reviews and the guideline of preferred reporting items for systematic review and meta-analysis (PRISMA) and synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. Inclusion criteria in this review were primary studies of every design, articles published in English around January 2000–October 2021, and the study used human as subject. A systematic literature finding was applied in 15 electronic scientific resources. The authors evaluated the study quality and risk of bias of each retrieved article. Results The authors found the study through electronic scientific resources that met inclusion and exclusion criteria. The authors evaluated 362 articles identified in literature searching, 22 articles met the criteria for this review and then underwent the evaluation of study quality and risk of bias. Conclusion COVID-19 infection can increase the risk of new-onset MG, myasthenic crisis, respiratory failure, and mortality rate due to cytokine storm in MG patients. The management of COVID-19 patients with MG is tailored to each person and based on national guidelines and local expert recommendations.

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“…The authors concluded that while eculizumab might have contributed to the lack of an immune response to the first vaccine, it was more likely related to concomitant treatment with mycophenolate and prednisone. 65 The risk of delaying vaccination, and thus failing to mitigate COVID-19 risk, should be balanced against a possible blunted response to the vaccine. As part of a collaborative decision-making process, this choice should be personalized.…”

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

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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.

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Immunogenicity of repeat COVID-19 mRNA vaccinations in a patient with myasthenia gravis receiving mycophenolate, prednisone, and eculizumab

Cited by 9 publications

References 9 publications

Vaccines and myasthenia gravis: a comprehensive review and retrospective study of SARS-CoV-2 vaccination in a large cohort of myasthenic patients

Vaccines and myasthenia gravis: a comprehensive review and retrospective study of SARS-CoV-2 vaccination in a large cohort of myasthenic patients

The relationship between myasthenia gravis and COVID-19: a systematic review

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

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