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COVID-19 in patients with myasthenia gravis: Epidemiology and disease course
Pietro Businaro1,2, Gloria Vaghi1,2, Enrico Marchioni3
1Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
Insights
Patients with myasthenia gravis (MG) do not face a higher risk of COVID-19 compared to the general population. COVID-19 infection had minimal impact on the disease course of MG patients in this study.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Myasthenia gravis (MG) patients, often on immunosuppressants, were hypothesized to be at increased risk for COVID-19.
- The study aimed to investigate the prevalence and characteristics of COVID-19 in MG patients.
Purpose of the Study:
- To determine the prevalence of COVID-19 in myasthenia gravis patients.
- To describe the clinical features and outcomes of COVID-19 in this population.
Main Methods:
- Telephonic interviews were conducted with 162 MG patients in May 2020.
- COVID-19 diagnosis was based on European Centre for Disease Prevention and Control criteria (probable or confirmed).
- Prevalence was compared to the overall population of the Pavia district.
Main Results:
- The prevalence of confirmed COVID-19 in MG patients (1.14%) was similar to the general population (0.87%) in the Pavia district.
- Higher Myasthenia Gravis Foundation of America clinical class and recent need for rescue treatment, not immunosuppressants, were linked to COVID-19 risk.
- Three of 11 MG patients with COVID-19 required ventilation, and two elderly patients died; only one patient experienced MG symptom worsening.
Conclusions:
- COVID-19 risk does not appear elevated in MG patients, irrespective of immunosuppressive therapy.
- COVID-19 had a limited effect on the clinical course of myasthenia gravis in the studied cohort.
Introduction/Aims:
Coronavirus disease 2019 (COVID-19), a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has become a global pandemic. Patients with myasthenia gravis (MG), often treated with immunosuppressants, might be at higher risk of developing COVID-19 and of demonstrating a severe disease course. We aimed to study prevalence and describe features of COVID-19 in MG patients.
Methods:
In May 2020, we conducted telephonic interviews with MG patients followed at our referral center. We collected structured data regarding MG and COVID-19, which was diagnosed as probable or confirmed according to the European Centre for Disease Prevention and Control case definition. We compared confirmed-COVID-19 prevalence calculated from the beginning of the pandemic in MG patients with that of the overall Pavia district.
Results:
We interviewed 162 MG patients (median age, 66 y; interquartile range 41-77; males 59.9%), 88 from the Pavia district. Three patients had SARS-CoV-2-confirmed by polymerase chain reaction and eight had probable-COVID-19. In the Pavia district, the prevalence of confirmed-COVID-19 among MG patients (1/88, 1.14%) and overall population (4777/546 515, 0.87%) did not differ (P = .538). Higher Myasthenia Gravis Foundation of America clinicalclass and the need for recent rescue treatment, but not ongoing immunosuppressive treatments, were associated with COVID-19 risk. Of 11 MG patients with probable/confirmed-COVID-19, 3 required ventilator support, and 2 elderly patients died of COVID-19 respiratory insufficiency. Only 1 of11 patients experienced worsening MG symptoms, which improved after increasing their steroid dose.
Discussion:
The risk of COVID-19 in MG patients seems to be no higher than that of the general population, regardless of immunosuppressive therapies. In our cohort, COVID-19 barely affected MG course.
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