Is Myasthenia Gravis a Real Complication of the COVID-19 Vaccine? A Case Report-Based Systematic Review

Mirmosayyeb, Omid; Ghaffary, Elham Moases; Mazdak, Mahsa; Bagheri, Zahra; Bagherieh, Sara; Shaygannejad, Vahid

doi:10.1155/2022/5009450

Cited by 7 publications

(11 citation statements)

References 55 publications

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“…Mirmosayyeb et al. ( 45 ) conducted a case report-based systematic review to investigate whether MG is a complication of COVID-19 vaccines. Four studies that reported five new-onset MG cases were included.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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BackgroundCOVID-19 vaccines are required for individuals with myasthenia gravis (MG), as these patients are more likely to experience severe pneumonia, myasthenia crises, and higher mortality rate. However, direct data on the safety of COVID-19 vaccines in patients with MG are lacking, which results in hesitation in vaccination. This scoping was conducted to collect and summarize the existing evidence on this issue.MethodsPubMed, Cochrane Library, and Web of Science were searched for studies using inclusion and exclusion criteria. Article titles, authors, study designs, demographics of patients, vaccination information, adverse events (AEs), significant findings, and conclusions of included studies were recorded and summarized.ResultsTwenty-nine studies conducted in 16 different countries in 2021 and 2022 were included. Study designs included case report, case series, cohort study, cross-sectional study, survey-based study, chart review, and systemic review. A total of 1347 patients were included. The vaccines used included BNT162b2, mRNA-1273, ChAdOx1 nCoV-19, inactivated vaccines, and recombinant subunit vaccines. Fifteen case studies included 48 patients reported that 23 experienced new-onset, and five patients experienced flare of symptoms. Eleven other types of studies included 1299 patients reported that nine patients experienced new-onset, and 60 participants experienced flare of symptoms. Common AEs included local pain, fatigue, asthenia, cephalalgia, fever, and myalgia. Most patients responded well to treatment without severe sequelae. Evidence gaps include limited strength of study designs, type and dose of vaccines varied, inconsistent window of risk and exacerbation criteria, limited number of participants, and lack of efficacy evaluation.ConclusionCOVID-19 vaccines may cause new-onset or worsening of MG in a small proportion of population. Large-scale, multicenter, prospective, and rigorous studies are required to verify their safety.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…Compared to previous vaccines, SARS-CoV-2 adjuvanticity acts as an agonist for TLR-7/8 or TLR-9. There is a possibility that this is a new pathogenic mechanism responsible for human immune-mediated diseases [ 100 ]. Meanwhile, the activation of adaptive immunity in response to vaccines is also governed by TLR pathways.…”

Section: Discussionmentioning

confidence: 99%

Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) following COVID-19 vaccines: A systematic review

et al. 2023

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“…To the best of our knowledge, previous publications on this topic were based primarily on descriptive reports including single case reports [11][12][13][14], case series [14,16], and systematic reviews [10,15].…”

Section: Ta B L Ementioning

confidence: 99%

“…Since the beginning of extensive COVID-19 global vaccination programs, several case reports and case series linking MG onset and MG exacerbations to COVID-19 vaccines have been published [11][12][13][14][15]. Hypothetical explanations for this association include molecular mimicry between SARS-CoV-2 molecules and human antigens, hyperstimulation of the innate immune system, and expression of subclinical latent pre-existing MG [12,15].…”

mentioning

confidence: 99%

Association between COVID‐19 vaccination and myasthenia gravis: A population‐based, nested case–control study

Arbel

Bishara

Barnett‐Griness

et al. 2023

Euro J of Neurology

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BackgroundExisting data regarding the link between COVID‐19 vaccine and myasthenia gravis (MG) are scarce. We aimed to assess the association between Pfizer‐BioNTech vaccine with both new‐onset MG and MG exacerbation.MethodsFor the first aim, we conducted a nested case‐control study in a cohort of 3,052,467 adults, without a diagnosis of MG, from the largest healthcare provider in Israel. Subjects were followed from January 1, 2021, until June 30, 2022, for the occurrence of MG. Ten randomly selected controls were matched to each case of new‐onset MG on age, and sex. For the second aim, a nested case‐control study was conducted in a cohort of 1,446 MG patients. Four randomly selected MG patients (controls) were matched to each case of MG exacerbation. Exposure to COVID‐19 vaccine in the prior four weeks was assessed in cases and controls.ResultsOverall, 332 patients had new‐onset MG and were matched with 3,320 controls. Multivariable conditional logistic regression models showed that the OR for new‐onset MG, associated with COVID‐19 vaccine, was 1.14 (95% CI, 0.73‐1.78). The results were consistent in sensitivity analysis that used more stringent criteria to define MG. Overall, 62 patients with MG exacerbation were matched to 248 MG controls. The multivariable OR for MG exacerbation, associated with COVID‐19 vaccine, was 1.35 (0.37‐4.89). All results were similar when the prior exposure to COVID‐19 vaccine was extended to 8 weeks.ConclusionsThis study suggests that Pfizer‐BioNTech vaccine is not associated with increased risk of new‐onset nor exacerbation of myasthenia gravis.

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Is Myasthenia Gravis a Real Complication of the COVID-19 Vaccine? A Case Report-Based Systematic Review

Cited by 7 publications

References 55 publications

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

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

Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) following COVID-19 vaccines: A systematic review

Association between COVID‐19 vaccination and myasthenia gravis: A population‐based, nested case–control study

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