Myotonic dystrophy type 1 as a major risk factor for severe COVID-19?

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is challenging health care systems worldwide. People with myotonic dystrophy type 1 (DM1) represent a high-risk population during infectious disease outbreaks, little is known about the potential impact of COVID-19 on patients with DM1. We studied the clinical course of COVID-19 in three hospitalized patients with myotonic dystrophy type 1 or Steinert's disease, between April 1, 2020-April 30-2020. All three had advanced Steinert's disease receiving non-invasive nocturnal home ventilatory support. Two of them lived in a residential care centre. Two patients had a limited respiratory capacity, whereas one patient had a rather preserved functional capacity but more comorbidities. Two out of three patients were obese, none of them had diabetes mellitus. Two patients received hydroxychloroquine. Despite maximal supportive care with oxygen therapy, antibiotics, intensive respiratory physiotherapy and noninvasive positive pressure ventilation, all three patients eventually died due to COVID-19. Our case series of three patients with DM1 admitted for COVID-19 confirms that they are at high risk for severe disease and poor outcome. Clinical trials are needed to define best practices and determinants of outcomes in this unique population.

Rehabilitation and COVID-19: a rapid living systematic review 2020 by Cochrane Rehabilitation Field. Update as of October 31st, 2020

“…After the removal of duplicates and the screening of titles and abstracts, 63 studies were retained, of which 22 were suitable for qualitative synthesis (Figure 1). The studies published in October 2020 were conducted in the following World Health Organization regions: 10 in Europe (Italy, 7-10 UK, 11,12 Belgium, 13,14 Germany 15 and Spain 16 ) and 10 in the Americas (USA, [17][18][19][20][21][22][23] Brazil 24,25 and Canada 26 ); one in Western Pacific (Australia 27 ) and one in the African region (Morocco). 28 A detailed overview of this update is provided as Supplementary Digital Material 1: Supplementary Table I (available on Cochrane Rehabilitation website).…”

“…Due to the heterogeneity of studies, a meta-analysis was not appropriate, and the results were described qualitatively. Based on the OCEBM 2011 Levels of Evidence table 29 the majority of studies (N.=17; 77.3%) were level 4 (six case report, 7,11,17,19,22,28 eight case series, 9,10,13,14,16,21,24,27 three historical cohort 20,23,26 ), whereas the remaining five were level 3 (four cohort studies 8,12,15,25 and one cross-sectional 18 study). No RCT or QRCTs were found in this update (Table I).…”

“…One descriptive study 26 reported data on late-onset manifestations and two studies on the impact of COVID-19 infection on people with pre-existing neurological diseases. 10,14 Seven studies reported the setting of rehabilitation service: according to the adopted classification, 5 they described four rehabilitation in acute care, 11,14,19,25 one general postacute, 26 one outpatient, 23 and one rehabilitation in the home. 27 According to the ICF-based classification of the limitations of functioning of rehabilitation interest (LFRI), most papers (N.=12; 55%) described the impact of COVID-19 infection on nervous system structure and related functions, 7, 9-12, 16, 18, 19, 21, 22, 24, 28 four studies reported on generic body structures and functions, 13,15,17,26 three on activity limitation and participation restriction, 20,23,27 two on respiratory structures and related functions, 8,14 and one on digestive function.…”

Myotoxic drugs and immunodeficiency may contribute to the poor outcome of COVID-19 patients with myotonic dystrophy

“…With interest we read the article by Dhont et al about three patients with myotonic dystrophy type 1 (MD1) who died from COVID-19 despite maximal therapy for the infection with SARS-CoV-2 [1]. It was concluded that MD1 patients are at high risk for severe COVID-19 disease with poor outcome [1]. We have the following comments and concerns.…”

“…All three patients with MD1 received chloroquine from which it is well known that it can be myotoxic [2]. Unfortunately, the authors did not provide the exact medication the three patients were receiving in addition to chloroquine [1]. From various antibiotics, including azithromycin, it is known that they can be myotoxic [3].…”