Myasthenia gravis due to hydroxychloroquine

Varan, Özkan; Küçük, Hamit; Tufan, Abdurrahman

doi:10.4081/reumatismo.2015.849

Cited by 30 publications

(25 citation statements)

References 3 publications

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“…Another question is whether hydroxychloroquine (HCQ) can be used in patients with pSS and MG. HCQ is an essential drug for patients with CTDs including SLE and SS, but special caution should be taken when used in MG patients. Although data from the Spanish society of Rheumatology Lupus Registry showed that HCQ protected against polyautoimmunity for patients with SLE ( 38 ), Varan et al reported a case of SLE in which MG developed with the use of HCQ, and regressed with its withdrawal ( 39 ). In a series of 17 patients with SLE and MG, Jallouli et al found that eight patients (47%) developed MG after initiation of HCQ, but only one patient who received HCQ had an exacerbation of myasthenic symptoms ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

Myasthenia Gravis Coexisting With Primary Sjögren's Syndrome: Report of Three Cases and Literature Review

Zhao

Liao

et al. 2020

Front. Neurol.

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Objective: The coexistence of myasthenia gravis (MG) and primary Sjögren's syndrome (pSS) is rarely reported. This study aims to describe the clinical features, treatment and outcome of MG coexisting with pSS. Materials and Methods: Herein we reported three cases with the two coexisting diseases, and also searched the PubMed, Medline databases, and China Wanfang databases for the relevant case reports written in English, Chinese, or Japanese with detailed data. Results: We reviewed a total of 17 patients with both diseases. Fifteen patients were female. The median age at onset was 48 years (range 28–78 years). MG was the initial disease in nine of 17 cases. The median interval between the onsets of the two diseases was 30 months (range 7 months to 20 years). The symptoms of MG included fatigable ptosis (64.7%), bulbar symptoms (58.8%), muscle fatigability (64.7%), diplopia (64.7%), dyspnea (23.5%), and facial paralysis (5.9%). Anti-acetylcholine receptor antibody was positive in 70.6% patients. All the patients had sicca symptoms. Manifestations of pSS also included swollen exocrine glands (23.5%), joint pain (23.5%), hair loss (11.8%), leukopenia (11.8%), recurrent oral ulcers (5.9%), Raynaud phenomenon (5.9%), and fever (5.9%). ANA positivity was present in 70.6% patients, anti-SSA positivity in 47.1%, and double positivity of anti-SSA and anti-SSB in 17.6%. There were 12 patients (70.6%) with two autoimmune diseases (pSS and MG), and five patients with more than two autoimmune diseases. Cholinesterase inhibitors were the most commonly prescribed drugs (82.4%). Seven patients received thymectomy and one patient improved after the operation. Two patients were given intravenous methylprednisolone pulse therapy, and four patients oral steroids combined with immunosuppressants initially. Intravenous immunoglobulin and plasma exchange were used in two patients, respectively, for the respiratory failure. All the patients improved following treatment except one patient who died of MG crisis due to medication withdrawal. Conclusion: The coexistence of SS with MG is quite rare. The onset of MG may occur before or after the diagnosis of SS. Co-morbidity with MG does not seem to adversely affect the course of SS. Thus, controlling the progress of MG is the critical aspect of treatment.

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Section: Discussionmentioning

confidence: 99%

Myasthenia Gravis Coexisting With Primary Sjögren's Syndrome: Report of Three Cases and Literature Review

Zhao

Liao

et al. 2020

Front. Neurol.

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“…Chloroquine and hydroxychloroquine have also been associated with new-onset or worsening MG and are typically used with caution in this patient group. 44,45 Azithromycin, a macrolide antibiotic, is also being used with chloroquine or hydroxychloroquine for COVID-19. Macrolide therapy, however, the most common being azithromycin, was not associated with reduced 90-day mortality or improvement in MERS-CoV RNA clearance in a study of patients with MERS.…”

Section: Ancillary Services/ Evaluationsmentioning

confidence: 99%

COVID-19 and neuromuscular disorders

2020

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The coronavirus 2019 pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. In a short period of time, it has already caused reorganization of neuromuscular clinical care delivery and education, which will likely have lasting effects on the field. This article reviews (1) potential neuromuscular complications of COVID-19, (2) assessment and mitigation of COVID-19-related risk for patients with preexisting neuromuscular disease, (3) guidance for management of immunosuppressive and immunomodulatory therapies, (4) practical guidance regarding neuromuscular care delivery, telemedicine, and education, and (5) effect on neuromuscular research. We outline key unanswered clinical questions and highlight the need for team-based and interspecialty collaboration. Primary goals of clinical research during this time are to develop evidence-based best practices and to minimize morbidity and mortality related to COVID-19 for patients with neuromuscular disorders.

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“…For this reason, we recommend a careful risk/benefit assessment before use in myopathic patients, and, in case of treatment with these agents, regular monitoring of serum CK levels. HCQ and azithromycin also have the potential to cause the onset or worsening of myasthenia gravis, and thus use in these patients should be carefully evaluated [65,90]. We do not recommend using these drugs as prophylaxis in NMD patients, as their prophylactic efficacy has not been proven and it may lead to serious toxicity [38].…”

Section: Treatments For Sars-cov-2 and Nmd Diseasesmentioning

confidence: 99%

Management of patients with neuromuscular disorders at the time of the SARS-CoV-2 pandemic

et al. 2020

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The novel Coronavirus disease-19 (COVID-19) pandemic has posed several challenges for neuromuscular disorder (NMD) patients. The risk of a severe course of SARS-CoV-2 infection is increased in all but the mildest forms of NMDs. High-risk conditions include reduced airway clearance due to oropharyngeal weakness and risk of worsening with fever, fasting or infection Isolation requirements may have an impact on treatment regimens administered in hospital settings, such as nusinersen, glucosidase alfa, intravenous immunoglobulin, and rituximab infusions. In addition, specific drugs for SARS-CoV2 infection under investigation impair neuromuscular function significantly; chloroquine and azithromycin are not recommended in myasthenia gravis without available ventilatory support and prolonged prone positioning may influence options for treatment. Other therapeutics may affect specific NMDs (metabolic, mitochondrial, myotonic diseases) and experimental approaches for Coronavirus disease 2019 may be offered "compassionately" only after consulting the patient's NMD specialist. In parallel, the reorganization of hospital and outpatient services may change the management of non-infected NMD patients and their caregivers, favouring at-distance approaches. However, the literature on the validation of telehealth in this subgroup of patients is scant. Thus, as the first wave of the pandemic is progressing, clinicians and researchers should address these crucial open issues to ensure adequate caring for NMD patients. This manuscript summarizes available evidence so far and provides guidance for both general neurologists and NMD specialists dealing with NMD patients in the time of COVID-19.

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Myasthenia gravis due to hydroxychloroquine

Abstract: <span lang="EN-US">No abstract available</span>

Cited by 30 publications

References 3 publications

Myasthenia Gravis Coexisting With Primary Sjögren's Syndrome: Report of Three Cases and Literature Review

Myasthenia Gravis Coexisting With Primary Sjögren's Syndrome: Report of Three Cases and Literature Review

COVID-19 and neuromuscular disorders

Management of patients with neuromuscular disorders at the time of the SARS-CoV-2 pandemic

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