Retrospective study on the safety of COVID‐19 vaccination in myasthenia gravis

Abstract

Introduction/Aim Given the lack of information on safety of coronavirus disease 2019 (COVID‐19) vaccination in myasthenia gravis (MG) patients, we aimed to review our experience after surveying patients, as part of routine clinical practice, to ensure that advice on safety is accurate. Methods We performed a retrospective chart review of MG patients from the Prosserman Family Neuromuscular Clinic at the Toronto General Hospital who received two injections of any COVID‐19 vaccine from February to August 2021. Demographic data were abstracted from the patient medical records. We assessed changes in the severity of MG using the virtual Myasthenia Gravis Impairment Index (vMGII), the simple single question (SSQ), and Patient Acceptable Symptom State (PASS). We also assessed adverse effects after vaccination. Results We included 200 patients with a mean age of 64.3 ± 13.9 y, 51.5% were men, and 82% had generalized MG. The vMGII, SSQ, and PASS scores remained stable after each vaccine dose, and at last follow‐up. Of the patients, 60% reported an adverse reaction after the first injection, and 56% after the second. The most common adverse reactions reported were local pain at the injection site, fatigue, headache, and fever. Discussion COVID‐19 vaccinations were well tolerated in MG patients and were not associated with worsening severity of their MG. The prevalence of vaccine‐related adverse reactions was the same as in the general population.

The safety of COVID-19 vaccines in patients with myasthenia gravis: A scoping review

“…Ten studies reported that 60 participants (60/1299, 4.62%) experienced exacerbations, and nine had new-onset MG (9/1299, 0.69%). One retrospective chart review reported no symptom flares in 200 patients with MG after vaccination ( 11 ). Common AEs reported in these studies included local pain, fatigue, asthenia, cephalalgia, fever, and myalgia.…”

“…Urra Pincheira et al. ( 11 ) conducted a retrospective chart review in Canada involving 200 patients who received two vaccine doses. In total, 147 patients received BNT162b2 (147/200, 73.50%), 24 received mRNA-1273 (24/200, 12.00%), and 12 received ChAdOx1 nCoV-19 (12/200, 6.00%).…”

“…The relationship between COVID-19 infection and myasthenia gravis (MG) exacerbation has been observed in numerous studies. In COVID-19-infected patients with MG, severe pneumonia and myasthenia crises are more frequent, and their mortality rate is considerably higher ( 10 , 11 ). Thirty-six of 91 patients who had both MG and COVID-19 infection were reported to experience flare of symptoms and required rescue therapy (36/91, 39.56%), and 22 died due to COVID-19 (22/91, 24.18%) ( 10 ).…”

Vaccination against COVID‐19 does not lead to exacerbation in patients with myasthenia gravis

“…In a previous issue of the Journal, Urra Pincheira et al 11 have attempted to provide more detailed information regarding the safety of COVID‐19 vaccination in a larger cohort of patients with myasthenia gravis. The study design allowed the authors to provide information not only regarding severe exacerbations, but also mild ones that did not result in hospitalization or death, but were still relevant to the patients.…”

“…More substantial population-based data (reflecting 32 million patients captured by the National Immunization Management System database in England) did report a slightly higher risk of hospitalization or death from myasthenic disorders 15-21 days after the first dose of adenoviral COVID-19 vaccine, although heightened risks with mRNA vaccines were not reported. 10 In a previous issue of the Journal, Urra Pincheira et al 11 have attempted to provide more detailed information regarding the safety of COVID-19 vaccination in a larger cohort of patients with myasthenia gravis. The study design allowed the authors to provide information not only regarding severe exacerbations, but also mild ones that did not result in hospitalization or death, but were still relevant to the patients.…”