Myasthenia gravis at the crossroad of COVID-19: focus on immunological and respiratory interplay

Galassi, Giuliana; Marchioni, Alessandro

doi:10.1007/s13760-021-01612-6

Cited by 31 publications

(37 citation statements)

References 76 publications

(172 reference statements)

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“…Sometimes this condition requires hospitalization for potentially lethal exacerbations that may be triggered by infections, stress, and vaccines [ 2 , 3 ]. Hence, the recent SARS-CoV-2 outbreak has led to several critical issues in the management of MG patients [ 4 , 5 , 6 , 7 ]. The first concern arises because many drugs used in the first phase of the Coronavirus Disease 2019 (COVID-19) pandemic (e.g., azithromycin, chloroquine, and hydroxychloroquine) are contraindicated in MG [ 8 , 9 ], with detrimental effects on these patients—there can be clinical worsening until myasthenic crisis in such cases [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 in AChR Myasthenia Gravis and the Safety of Vaccines: Data from an Italian Cohort

Lupica

Stefano

Iacono

et al. 2022

Neurology International

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Background and aims. Patients with Myasthenia gravis (MG) are considered vulnerable as they may present with respiratory muscle weakness and because they are on immunosuppressive treatment; thereby, COVID-19 may have a detrimental effect on these patients. Vaccines against COVID-19 are currently available and it has been shown as they can prevent severe COVID-19 in vulnerable patients. Notwithstanding their efficacy, vaccine hesitancy has not been completely dispelled in the general population. Unfortunately, there is limited data about the safety of these vaccines in MG patients. The aims of this study are to evaluate the impact of COVID-19 in a MG cohort, the adherence to COVID-19 vaccination in Italy and vaccine safety in MG patients. Methods. A retrospective cohort study of MG patients attending the Neuromuscular Clinic of the University Hospital “Paolo Giaccone” of Palermo, Italy, was performed. Patients underwent telephone interviews with a dedicated questionnaire on SARS-CoV-2 vaccination and infection. Vaccine safety was assessed though the evaluation of vaccine-related adverse events (AEs) and comparisons of MG-ADL scores before and after vaccination. Patient worsening was defined as two or more point increases in MG-ADL scores. Results. From a total of 90 participants, 75 answered the questionnaire and 70.5% of them (n = 53) received the vaccine; ten patients did not receive vaccination and 3 patients were partially vaccinated. Among the vaccinated patients, about 45% (n = 24) experienced at least one AE, with a complete resolution within one week. No serious AEs and life-threatening conditions were observed. Globally, MG-ADL scores did not worsen after vaccination. Nine unvaccinated patients experienced SARS-CoV2 infection and four of them (44%) died—one patient required respiratory support, whereas three patients were asymptomatic. Conclusions. COVID-19 significantly impacted MG patients with an increase in mortality due to respiratory sequelae. Vaccines against SARS-CoV-2 showed good short-term safety in MG patients, who may take advantage of vaccination to avoiding life-threatening complications such as COVID-19 pneumonia.

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Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 in AChR Myasthenia Gravis and the Safety of Vaccines: Data from an Italian Cohort

Lupica

Stefano

Iacono

et al. 2022

Neurology International

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“…Bene cial effect of IL-6 inhibitors in Covid-19 infection can be explained with hypothetical mechanisms by which viral antigens can stimulate production of cytokines, like IL-6, responsible for migration neutrophils in the lung, resulting in alveolar damage. These cytokines are responsible for utility to differentiation of B cells into plasma cells when production of autoantibodies is ampli ed in patients with MG [17]. Three presented MG patients developed renal insu ciency and decrease in saturation accompanied by an increase IL-6 during Covid-19 infection.…”

Section: Discussion Conclusionmentioning

confidence: 99%

Outcome myasthenia gravis patients with Covid-19

Martić¹,

Jovin

Udovičić³

et al. 2022

Preprint

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Background: Previous data about myasthenia gravis (MG) patients with Covid-19 are sporadic and insufficient to make any conclusion how they affect each other. Therefore, we present our experience with a group of MG patients who were infected with Covid-19.Cases presentation: We present clinical outcome in 13 patients with generalized autoimmune MG and COVID-19. Patients were divided into two groups depending on severity of clinical condition: more severe- those who required hospitalization and group treated at home with milder condition. Almost equal number of patients were in the group of hospitalized (7 patients) and treated at home (6 patients). Only men were in more severe group, while milder group consisted of both sexes equally. Exacerbation of myasthenic weakness developed only in hospitalized patients, among three lethal outcomes. Clinical remission of MG noted in 2 of 3 patients treated with tocilizumab. Clinical course of the disease commented in both groups.Conclusion: more severe clinical conditions and egzarcerbations of MG observed in middle aged male patients predominantly, among 3 of them died.

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“…In a survey of about 11,000 COVID-19 patients, 2 new MG patients were found ( Yuksel et al, 2021 ). The mechanism may be related to the immune disorder and inflammation caused by infection ( Galassi and Marchioni, 2021 , Qin et al, 2020 ). Research on MG patients infected with COVID-19 showed that among 3558 MG patients, 34 patients (0.96%) were infected with COVID-19 ( Solé et al, 2021 ).…”

Section: Nervous System Diseases Related To Sars-cov-2mentioning

confidence: 99%